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NPI Code Detail

MEDICARE: EDNA ROCIO YOUNGBLOOD NP

MEDICARE: EDNA ROCIO YOUNGBLOOD NP
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
1363LF0000XFamily Nurse Practitioner1171106TX

General Provider Information

NPI Number : 1093555849
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA ROCIO YOUNGBLOOD NP
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-6483
Fax Number : 682-885-3113
Provider Business Practice Location Address
First Line : 801 7TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2733
Country : US
Telephone Number : 682-885-4095
Fax Number : 682-885-7499
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2024
Last Update Date : 05/26/2026

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Directions to “ EDNA ROCIO YOUNGBLOOD NP” Practice Location

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