MEDICARE: MRS. BIANCA ALICIA JACLYN PEASE 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	1123563	TX

General Provider Information

NPI Number	:	1316630239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BIANCA ALICIA JACLYN PEASE FNP-BC

Provider Business Mailing Address
First Line	:	12576 TWIN LEAF DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-5837
Country	:	US
Telephone Number	:	915-867-6252
Fax Number	:

Provider Business Practice Location Address
First Line	:	8623 N LOOP DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-4520
Country	:	US
Telephone Number	:	915-881-4155
Fax Number	:

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

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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