=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487251765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA ROSE BECCONE APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2020
-----------------------------------------------------
Last Update Date | 10/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3537 S I 35 E STE 317
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-6870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-808-0906
-----------------------------------------------------
Fax | 940-808-0925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4928 EL CAMPO AVE APT 224
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76107-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-874-1691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1010771
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------