MEDICARE: AMBER ELIZABETH MACHALA 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	363LP2300X	Primary Care Nurse Practitioner	1150356	TX

General Provider Information

NPI Number	:	1578324034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ELIZABETH MACHALA APRN, FNP-C

Provider Business Mailing Address
First Line	:	849 WYLIE ST
Second Line	:
City	:	CROWLEY
State	:	TX
Zip	:	76036-3727
Country	:	US
Telephone Number	:	810-955-2473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 BRIDGEWOOD DR STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-0809
Country	:	US
Telephone Number	:	817-922-8182
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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