MEDICARE: JANET A NASH NP

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	363LP2300X	Primary Care Nurse Practitioner	625887	TX

General Provider Information

NPI Number	:	1063443521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET A NASH NP

Provider Business Mailing Address
First Line	:	2923 LA RODA
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6502
Country	:	US
Telephone Number	:	954-693-0000
Fax Number	:	954-693-0005

Provider Business Practice Location Address
First Line	:	2923 LA RODA
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6502
Country	:	US
Telephone Number	:	469-222-8338
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	10/25/2018

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