MEDICARE: VANNICA SOY FNP-C

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	207N00000X	Dermatology Physician	1009473	TX

General Provider Information

NPI Number	:	1245843473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANNICA SOY FNP-C

Provider Business Mailing Address
First Line	:	18422 MAPLE MILL DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4523
Country	:	US
Telephone Number	:	832-790-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	27150 HIGHWAY 290 STE 100
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-7224
Country	:	US
Telephone Number	:	832-653-3300
Fax Number	:	832-653-6407

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

Provider Enumeration Date	:	08/27/2020
Last Update Date	:	08/27/2020

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