MEDICARE: ERICA SCOTT F.N.P

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	669291	TX
2	363L00000X	Nurse Practitioner	COA.12353NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225290067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA SCOTT F.N.P

Provider Business Mailing Address
First Line	:	1617 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4709
Country	:	US
Telephone Number	:	817-927-3554
Fax Number	:	817-927-3603

Provider Business Practice Location Address
First Line	:	1617 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4709
Country	:	US
Telephone Number	:	817-927-3554
Fax Number	:	817-927-3603

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

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	04/09/2012

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