MEDICARE: TEENA BHAKTA CFNP

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	126359	TX

General Provider Information

NPI Number	:	1548660178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEENA BHAKTA CFNP

Provider Business Mailing Address
First Line	:	14041 NORTHWEST BLVD
Second Line	:	STE 1
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5137
Country	:	US
Telephone Number	:	361-767-9963
Fax Number	:	361-767-8477

Provider Business Practice Location Address
First Line	:	14041 NORTHWEST BLVD
Second Line	:	STE 1
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5137
Country	:	US
Telephone Number	:	361-767-9963
Fax Number	:	361-767-8477

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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