MEDICARE: ADVANCED PRIMARY CARE PRACTICE, LLC

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1285273854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRIMARY CARE PRACTICE, LLC

Provider Business Mailing Address
First Line	:	2537 GOLDEN BEAR DR
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2377
Country	:	US
Telephone Number	:	214-954-4114
Fax Number	:	214-880-0053

Provider Business Practice Location Address
First Line	:	16750 WESTGROVE DR
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-5688
Country	:	US
Telephone Number	:	214-954-4114
Fax Number	:	214-880-0053

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. ROBIN UNDERHILL
Credential	:
Telephone Number	:	214-954-4114

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	12/16/2022

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