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NPI Code Detail

MEDICARE: AMICUA BRECKENRIDGE FNP-C

MEDICARE: AMICUA BRECKENRIDGE 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
1363LF0000XFamily Nurse Practitioner1179517TX

General Provider Information

NPI Number : 1962218917
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMICUA BRECKENRIDGE FNP-C
Provider Business Mailing Address
First Line : 6104 S 1ST ST STE 102
Second Line :
City : AUSTIN
State : TX
Zip : 78745-4052
Country : US
Telephone Number : 512-856-9596
Fax Number :
Provider Business Practice Location Address
First Line : 6104 S 1ST ST STE 102
Second Line :
City : AUSTIN
State : TX
Zip : 78745-4052
Country : US
Telephone Number : 512-856-9596
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2024
Last Update Date : 11/19/2025

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Directions to “ AMICUA BRECKENRIDGE FNP-C” Practice Location

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