MEDICARE: NANCY EILEEN ROSS RN 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	251275	TX
2	363LF0000X	Family Nurse Practitioner	AP113895	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8Y3701	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1477733038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY EILEEN ROSS RN FNP

Provider Business Mailing Address
First Line	:	301 UNIVERSITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77555-0737
Country	:	US
Telephone Number	:	832-505-0139
Fax Number	:	832-505-0161

Provider Business Practice Location Address
First Line	:	2785 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4979
Country	:	US
Telephone Number	:	832-505-0139
Fax Number	:	832-505-0161

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

Provider Enumeration Date	:	11/11/2007
Last Update Date	:	11/03/2023

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