MEDICARE: ANDREW NGUYEN DAO 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	AP136837	TX
2	207Q00000X	Family Medicine Physician	AP136837	TX
3	208000000X	Pediatrics Physician	AP136837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP136837	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1447752852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW NGUYEN DAO FNP-C

Provider Business Mailing Address
First Line	:	1909 SCHUMAC LN
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4759 SOUTH FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-3655
Country	:	US
Telephone Number	:	817-923-7374
Fax Number	:

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

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/17/2018

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