MEDICARE: DESIREE MARIA FALCON 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	1058634	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1058634	OTHER	TX	TEXAS BOARD OF NURSING APRN

General Provider Information

NPI Number	:	1649925405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE MARIA FALCON FNP-C

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	561-570-5172
Fax Number	:	786-472-5770

Provider Business Practice Location Address
First Line	:	1567 GOLIAD RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2719
Country	:	US
Telephone Number	:	726-202-0998
Fax Number	:

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

Provider Enumeration Date	:	02/19/2022
Last Update Date	:	05/07/2024

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