MEDICARE: MELISSA M BALTAZAR DNP

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	1216330	TX
2	363LG0600X	Gerontology Nurse Practitioner	1216330	TX

General Provider Information

NPI Number	:	1932983772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA M BALTAZAR DNP

Provider Business Mailing Address
First Line	:	3701 W NORTHWEST HWY STE 191
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4972
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 W NORTHWEST HWY STE 191
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4972
Country	:	US
Telephone Number	:	469-606-9590
Fax Number	:	877-975-2001

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	05/25/2026

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