MEDICARE: MRS. AMELIA LEAL-SERRATA FNP-BC

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	AP126228	TX

General Provider Information

NPI Number	:	1043697030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMELIA LEAL-SERRATA FNP-BC

Provider Business Mailing Address
First Line	:	4900 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235
Country	:	US
Telephone Number	:	214-590-4900
Fax Number	:	214-590-6950

Provider Business Practice Location Address
First Line	:	4900 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7719
Country	:	US
Telephone Number	:	214-590-4900
Fax Number	:	214-590-6950

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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