MEDICARE: SANDIA VENORD

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	363LA2200X	Adult Health Nurse Practitioner	1038831	TX
2	363LP2300X	Primary Care Nurse Practitioner	1038831	TX

General Provider Information

NPI Number	:	1124783642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDIA VENORD

Provider Business Mailing Address
First Line	:	5313 VESTIA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6720
Country	:	US
Telephone Number	:	407-924-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	5313 VESTIA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6720
Country	:	US
Telephone Number	:	407-924-7718
Fax Number	:

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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Directions to “ SANDIA VENORD ” Practice Location

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