MEDICARE: IVAN SRDANOVIC PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP144239	TX

General Provider Information

NPI Number	:	1184262735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN SRDANOVIC PMHNP-BC

Provider Business Mailing Address
First Line	:	2200 N A W GRIMES BLVD STE 600
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2745
Country	:	US
Telephone Number	:	512-655-3104
Fax Number	:	833-955-3628

Provider Business Practice Location Address
First Line	:	2200 N A W GRIMES BLVD STE 600
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2745
Country	:	US
Telephone Number	:	512-655-3104
Fax Number	:	833-955-3628

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

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	04/14/2025

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