MEDICARE: MRS. TANTASHA LATREECE JONES FNP

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	637058	TX

General Provider Information

NPI Number	:	1386075497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANTASHA LATREECE JONES FNP

Provider Business Mailing Address
First Line	:	10911 CLEAR FORK DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-2461
Country	:	US
Telephone Number	:	832-289-2706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2470 GRAY FALLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6512
Country	:	US
Telephone Number	:	281-978-4520
Fax Number	:

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

Provider Enumeration Date	:	11/29/2013
Last Update Date	:	11/29/2013

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