MEDICARE: NANCY MORENO NP

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	363LA2100X	Acute Care Nurse Practitioner	1094742	TX

General Provider Information

NPI Number	:	1497471890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MORENO NP

Provider Business Mailing Address
First Line	:	3921 ESTRELLA CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-3263
Country	:	US
Telephone Number	:	817-733-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 SUNSET DR STE 670
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5547
Country	:	US
Telephone Number	:	682-990-3018
Fax Number	:

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

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	10/17/2022

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