MEDICARE: ADVANCE PRACTICE NURSE CONSULTANTS PLLC

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	693274	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	693274	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1639656473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE PRACTICE NURSE CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	210 S CANTON ST
Second Line	:
City	:	MABANK
State	:	TX
Zip	:	75147-2367
Country	:	US
Telephone Number	:	903-539-2958
Fax Number	:

Provider Business Practice Location Address
First Line	:	874 ED HALL DR STE 106
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1800
Country	:	US
Telephone Number	:	903-539-2958
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIK TIJERINA
Credential	:	NP
Telephone Number	:	903-539-2958

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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