MEDICARE: GERALDINE M DISNARD MSN MPH RNC PMHNP

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	363L00000X	Nurse Practitioner	235929 (PMHNP)	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP 9274840	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366443822	OTHER	TX	NPI
2	1467694935	OTHER	FL	NPI

General Provider Information

NPI Number	:	1366443822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE M DISNARD MSN MPH RNC PMHNP

Provider Business Mailing Address
First Line	:	3115 FORT WORTH HWY
Second Line	:	# 200
City	:	HUDSON OAKS
State	:	TX
Zip	:	76087-8720
Country	:	US
Telephone Number	:	817-694-4978
Fax Number	:	817-448-9088

Provider Business Practice Location Address
First Line	:	3115 FORT WORTH HWY
Second Line	:	# 200
City	:	HUDSON OAKS
State	:	TX
Zip	:	76087-8720
Country	:	US
Telephone Number	:	817-694-4978
Fax Number	:	817-448-9088

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/06/2010

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