MEDICARE: BIANCA ADRIANNA AGNELLO 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	363LF0000X	Family Nurse Practitioner	1002992	TX

General Provider Information

NPI Number	:	1275148793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA ADRIANNA AGNELLO FNP-C

Provider Business Mailing Address
First Line	:	8465 BOAT CLUB RD STE 115
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76179-3676
Country	:	US
Telephone Number	:	817-260-0535
Fax Number	:	817-984-1448

Provider Business Practice Location Address
First Line	:	8465 BOAT CLUB RD STE 115
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3676
Country	:	US
Telephone Number	:	817-260-0535
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	03/12/2026

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