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NPI Code Detail

MEDICARE: MRS. JESSICA BROOKE SAMPLE RN, CPNP-PC

MEDICARE:  MRS. JESSICA BROOKE SAMPLE  RN, CPNP-PC
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
1363L00000XNurse PractitionerAP117352TX
2363LP0200XPediatric Nurse Practitioner689425TX

General Provider Information

NPI Number : 1093950115
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA BROOKE SAMPLE RN, CPNP-PC
Provider Business Mailing Address
First Line : 7777 FOREST LN STE C300J
Second Line :
City : DALLAS
State : TX
Zip : 75230-2604
Country : US
Telephone Number : 972-566-7730
Fax Number :
Provider Business Practice Location Address
First Line : 7777 FOREST LN STE C300J
Second Line :
City : DALLAS
State : TX
Zip : 75230-2604
Country : US
Telephone Number : 972-566-2043
Fax Number : 972-566-7437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2008
Last Update Date : 05/28/2024

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Directions to “ MRS. JESSICA BROOKE SAMPLE RN, CPNP-PC” Practice Location

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