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NPI Code Detail

MEDICARE: ANTARA HUMAGAIN FNP-C

MEDICARE: ANTARA HUMAGAIN FNP-C
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
1363LF0000XFamily Nurse Practitioner1218756TX

General Provider Information

NPI Number : 1235083924
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTARA HUMAGAIN FNP-C
Provider Business Mailing Address
First Line : 17007 SPANISH STAR DR
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-2505
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2537 GOLDEN BEAR DR
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-2377
Country : US
Telephone Number : 214-954-4114
Fax Number : 214-880-0053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2026
Last Update Date : 02/26/2026

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Directions to “ ANTARA HUMAGAIN FNP-C” Practice Location

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