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General NPI Number Information
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NPI Number | 1730728403
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Entity Type | Organization
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Legal Business Name | 360 HEALTH INTEGRATED MEDICAL BOUTIQUE, PLLC
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Dates
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Enumeration Date | 12/30/2019
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1190 W PIONEER PKWY
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City | ARLINGTON
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State | TX
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Zip | 76013-6367
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Country | US
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Telephone | 682-276-6595
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Fax | 817-583-6543
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Provider Business Mailing Address
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Address Line | 1190 W PIONEER PKWY
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City | ARLINGTON
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State | TX
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Zip | 76013-6367
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Country | US
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Telephone | 682-276-6595
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Fax | 817-583-6543
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. TRACY JULIEN
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Credential | FNP-C
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Telephone | 504-215-3919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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