MEDICARE: MRS. JOHARA USUDAN CANTU FNP

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	363LF0000X	Family Nurse Practitioner	1022927	TX

General Provider Information

NPI Number	:	1699350959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHARA USUDAN CANTU FNP

Provider Business Mailing Address
First Line	:	2046 S MCCOLL RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-0228
Country	:	US
Telephone Number	:	956-393-2200
Fax Number	:	956-393-2201

Provider Business Practice Location Address
First Line	:	2046 S MCCOLL RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-0228
Country	:	US
Telephone Number	:	956-393-2200
Fax Number	:	956-393-2201

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	04/28/2026

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