Healthcare Provider Details

I. General information

NPI: 1063066678
Provider Name (Legal Business Name): VICTORINE MUMEH ANZICK DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HARRY HINES BLVD
DALLAS TX
75235-7709
US

IV. Provider business mailing address

5200 HARRY HINES BLVD
DALLAS TX
75235-7709
US

V. Phone/Fax

Practice location:
  • Phone: 214-991-1381
  • Fax:
Mailing address:
  • Phone: 214-991-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: