MEDICARE: JACINTA ADAUGO UNAMBA

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	1002909	TX

General Provider Information

NPI Number	:	1710590658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACINTA ADAUGO UNAMBA

Provider Business Mailing Address
First Line	:	2217 HOLLOW WAY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-2189
Country	:	US
Telephone Number	:	214-457-5765
Fax Number	:

Provider Business Practice Location Address
First Line	:	2217 HOLLOW WAY
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-2189
Country	:	US
Telephone Number	:	214-457-5765
Fax Number	:

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

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	08/29/2020

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Directions to “ JACINTA ADAUGO UNAMBA ” Practice Location

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