MEDICARE: MARISA VICTORIA PODOLAK FNP-BC

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	1235451	TX

General Provider Information

NPI Number	:	1295661817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA VICTORIA PODOLAK FNP-BC

Provider Business Mailing Address
First Line	:	2005 WINONA DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-2726
Country	:	US
Telephone Number	:	214-471-1641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 WINONA DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-2726
Country	:	US
Telephone Number	:	214-471-1641
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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