Provider Demographics
NPI:1992735674
Name:SHAKIN, NANCY A (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:SHAKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 W HWY 71
Mailing Address - Street 2:STE F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8231
Mailing Address - Country:US
Mailing Address - Phone:512-610-5151
Mailing Address - Fax:
Practice Address - Street 1:7610 W HWY 71
Practice Address - Street 2:STE F
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:512-610-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181346102Medicaid
TX181346101Medicaid
TX8N8785OtherBCBS
TX1992735674OtherBLUE CROSS BLUE SHIELD
TX181346101Medicaid
TX8D9879Medicare PIN
TXS93455Medicare UPIN