MEDICARE: ANN AGBOR APRN-CNP, RN

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
1	363LF0000X	Family Nurse Practitioner	225428	TX

General Provider Information

NPI Number	:	1043062763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN AGBOR APRN-CNP, RN

Provider Business Mailing Address
First Line	:	117 LANTANA LN
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-4636
Country	:	US
Telephone Number	:	214-908-4483
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 LANTANA LN
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-4636
Country	:	US
Telephone Number	:	214-908-4483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	10/09/2025

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