Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP142064 | TX |
NPI | 1023657566 |
---|---|
Provider Name | Deepa Gaba |
First Address | Austin, TX 78731-5628 |
Second Address | Round Rock, TX 78665-3311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |