MEDICARE: NICOLE ONA AGACNP-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	363LA2100X	Acute Care Nurse Practitioner	AP145368	TX

General Provider Information

NPI Number	:	1588299861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ONA AGACNP-BC

Provider Business Mailing Address
First Line	:	10658 CHAPEL HILL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-3905
Country	:	US
Telephone Number	:	832-573-5646
Fax Number	:

Provider Business Practice Location Address
First Line	:	6609 W SAM HOUSTON PKWY S STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1641
Country	:	US
Telephone Number	:	713-595-9000
Fax Number	:	713-595-8500

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

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	03/11/2020

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