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NPI Code Detail

MEDICARE: IDA CENTINEO FNP-C

MEDICARE: IDA CENTINEO FNP-C
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
1363LF0000XFamily Nurse Practitioner352903NY
2363LF0000XFamily Nurse Practitioner1030675TX
3363LF0000XFamily Nurse Practitioner26NJ01038600NJ

General Provider Information

NPI Number : 1609410653
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDA CENTINEO FNP-C
Provider Business Mailing Address
First Line : 440 LOUISIANA ST STE 900
Second Line :
City : HOUSTON
State : TX
Zip : 77002-1062
Country : US
Telephone Number : 346-600-1925
Fax Number :
Provider Business Practice Location Address
First Line : 440 LOUISIANA ST STE 900
Second Line :
City : HOUSTON
State : TX
Zip : 77002-1062
Country : US
Telephone Number : 346-600-1925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2019
Last Update Date : 04/27/2026

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Directions to “ IDA CENTINEO FNP-C” Practice Location

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