Provider Demographics
NPI:1356591432
Name:BOURKE, DANA R (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:BOURKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1320 WONDER WORLD DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7558
Mailing Address - Country:US
Mailing Address - Phone:830-693-9355
Mailing Address - Fax:
Practice Address - Street 1:1920 CORPORATE DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6283
Practice Address - Country:US
Practice Address - Phone:512-878-6330
Practice Address - Fax:512-878-6941
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01963318OtherRR MEDICARE
TX581511YMG2OtherMEDICARE
TX372473401Medicaid