MEDICARE: TATIANA CANON

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	1151294	TX

General Provider Information

NPI Number	:	1467131706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA CANON

Provider Business Mailing Address
First Line	:	10523 ALCOTT DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-2002
Country	:	US
Telephone Number	:	832-248-9586
Fax Number	:

Provider Business Practice Location Address
First Line	:	6306 FAIRBANKS N HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-5192
Country	:	US
Telephone Number	:	832-831-9094
Fax Number	:

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

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	05/22/2025

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Directions to “ TATIANA CANON ” Practice Location

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