Healthcare Provider Details

I. General information

NPI: 1720570260
Provider Name (Legal Business Name): JANET ANNE MACTURK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 02/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 CYPRESS CREEK RD STE 104
CEDAR PARK TX
78613-4151
US

IV. Provider business mailing address

825 DREAM CATCHER DR
LEANDER TX
78641-4417
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-7966
  • Fax:
Mailing address:
  • Phone: 410-259-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137489
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: