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NPI Code Detail

MEDICARE: ELIZABETH COVARRUBIAS MENDOZA CPNP

MEDICARE: ELIZABETH COVARRUBIAS MENDOZA CPNP
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
1363L00000XNurse PractitionerAP116888TX
2363LP0200XPediatric Nurse Practitioner707287TX
3363LP2300XPrimary Care Nurse PractitionerAP116888TX

General Provider Information

NPI Number : 1467604777
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH COVARRUBIAS MENDOZA CPNP
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-6483
Fax Number : 682-885-3113
Provider Business Practice Location Address
First Line : 2755 MILLER AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76105-4164
Country : US
Telephone Number : 817-534-7110
Fax Number : 817-413-0521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2008
Last Update Date : 07/15/2025

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