MEDICARE: MS. NINA SOMALIE FAKUNLE 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	AP137872	TX

General Provider Information

NPI Number	:	1578111340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NINA SOMALIE FAKUNLE FNP-C

Provider Business Mailing Address
First Line	:	6500 GREENVILLE AVE STE 430
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 GREENVILLE AVE STE 430
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1014
Country	:	US
Telephone Number	:	214-838-6469
Fax Number	:

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

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	02/02/2026

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