MEDICARE: JOANNA LARSON FNP

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	AP140730	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP140730	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1326681669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LARSON FNP

Provider Business Mailing Address
First Line	:	6655 TRAVIS ST STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1343
Country	:	US
Telephone Number	:	713-500-8370
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 TRAVIS ST STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1343
Country	:	US
Telephone Number	:	713-500-8370
Fax Number	:

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

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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