MEDICARE: AMANDA ROSE ENGELMAN 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
1	363LF0000X	Family Nurse Practitioner	1151128	TX

General Provider Information

NPI Number	:	1407618358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ROSE ENGELMAN FNP-C

Provider Business Mailing Address
First Line	:	3854 DUCHESS TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-5241
Country	:	US
Telephone Number	:	214-498-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 N HALL ST STE 108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1321
Country	:	US
Telephone Number	:	214-820-0129
Fax Number	:

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

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/26/2024

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