Provider Demographics
NPI:1194423541
Name:DAUKSAVAGE, NICOLE (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:DAUKSAVAGE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 CAMERON LN
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-6594
Mailing Address - Country:US
Mailing Address - Phone:972-989-4627
Mailing Address - Fax:
Practice Address - Street 1:2004 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7317
Practice Address - Country:US
Practice Address - Phone:972-722-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1108426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily