MEDICARE: JUSTINE SELF FNP

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	AP138188	TX

General Provider Information

NPI Number	:	1104303205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE SELF FNP

Provider Business Mailing Address
First Line	:	7000 N. MOPAC EXPY, STE #420
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731
Country	:	US
Telephone Number	:	512-482-0045
Fax Number	:

Provider Business Practice Location Address
First Line	:	4681 COLLEGE PARK
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1526
Country	:	US
Telephone Number	:	512-671-1100
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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