MEDICARE: MINDS OF GOLD

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	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1659126357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDS OF GOLD

Provider Business Mailing Address
First Line	:	5301 ALPHA RD STE 80
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4393
Country	:	US
Telephone Number	:	469-469-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 ALPHA RD STE 80
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4393
Country	:	US
Telephone Number	:	469-469-5458
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	TONIKA LUDELL LAFLORA
Credential	:	NP
Telephone Number	:	469-469-5458

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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Directions to “MINDS OF GOLD ” Practice Location

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