MEDICARE: MISS SHARAN LYNN ALLEN NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP146160	TX

General Provider Information

NPI Number	:	1003430026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHARAN LYNN ALLEN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4401 PARK SPRINGS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-2016
Country	:	US
Telephone Number	:	817-807-9060
Fax Number	:	817-419-4505

Provider Business Practice Location Address
First Line	:	4401 PARK SPRINGS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-2016
Country	:	US
Telephone Number	:	817-807-9060
Fax Number	:	817-419-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	12/01/2022

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