Provider Demographics
NPI:1306151204
Name:GEORGE, SUNILA (NP)
Entity type:Individual
Prefix:
First Name:SUNILA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUNILA
Other - Middle Name:
Other - Last Name:SKARIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1900 MISTLETOE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4014
Mailing Address - Country:US
Mailing Address - Phone:817-338-1300
Mailing Address - Fax:
Practice Address - Street 1:1900 MISTLETOE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4014
Practice Address - Country:US
Practice Address - Phone:817-338-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX761556363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care