MEDICARE: GENE MARIE LEGASPI AGACNP

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	363LA2100X	Acute Care Nurse Practitioner	AP144003	TX

General Provider Information

NPI Number	:	1063044204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE MARIE LEGASPI AGACNP

Provider Business Mailing Address
First Line	:	5543 LAVACA RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-8565
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-0001
Country	:	US
Telephone Number	:	214-645-7700
Fax Number	:	214-645-7701

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/06/2020

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