Provider Demographics
NPI:1588908420
Name:FROCK, PAIGE DELIA HARMONY (APRN, CPNP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:DELIA HARMONY
Last Name:FROCK
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:DELIA
Other - Last Name:HARMONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CPNP
Mailing Address - Street 1:5301 ROSS RD STE H
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3291
Mailing Address - Country:US
Mailing Address - Phone:512-386-3335
Mailing Address - Fax:512-386-3341
Practice Address - Street 1:5301 ROSS RD STE H
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3291
Practice Address - Country:US
Practice Address - Phone:512-386-3335
Practice Address - Fax:512-386-3341
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122751363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3231607-01Medicaid
TX825776OtherSTATE BOARD LICNESEREGISTERED NURSE
TXAP122751OtherSTATE BOARD LICENSEPEDIATRIC NURSE PRACTITIONER