MEDICARE: MR. OMAR MUNIZ MSN, APRN, 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	1058467	TX

General Provider Information

NPI Number	:	1508519299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OMAR MUNIZ MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 596
Second Line	:
City	:	NEW DIANA
State	:	TX
Zip	:	75640-0596
Country	:	US
Telephone Number	:	903-738-5310
Fax Number	:

Provider Business Practice Location Address
First Line	:	737 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4340
Country	:	US
Telephone Number	:	214-946-9732
Fax Number	:

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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