MEDICARE: SHAINA JAYDE ARELLANO FNP-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	363LF0000X	Family Nurse Practitioner	AP144642	TX
2	363LF0000X	Family Nurse Practitioner	871139	TX

General Provider Information

NPI Number	:	1285271361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAINA JAYDE ARELLANO FNP-BC

Provider Business Mailing Address
First Line	:	4200 SOUTH FWY STE 1990
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 SOUTH FWY STE 1990
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1415
Country	:	US
Telephone Number	:	682-990-6491
Fax Number	:

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

Provider Enumeration Date	:	12/07/2019
Last Update Date	:	05/21/2024

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