Provider Demographics
NPI:1386170462
Name:MORALES, NICHOLE BRENNAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:BRENNAN
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:CATHERINE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7011 RIBELIN RANCH DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-6089
Mailing Address - Country:US
Mailing Address - Phone:512-345-7436
Mailing Address - Fax:512-346-7436
Practice Address - Street 1:7011 RIBELIN RANCH DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-6089
Practice Address - Country:US
Practice Address - Phone:512-345-7436
Practice Address - Fax:512-346-7436
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13663363A00000X
NC0010-07135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant