MEDICARE: MRS. ERIN LEIGH MCGUIRE 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
1	363LF0000X	Family Nurse Practitioner	AP136582	TX

General Provider Information

NPI Number	:	1740782069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN LEIGH MCGUIRE FNP-C

Provider Business Mailing Address
First Line	:	5421 SANTA MARIE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-4547
Country	:	US
Telephone Number	:	903-814-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S HULEN ST STE 450
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4910
Country	:	US
Telephone Number	:	817-524-1811
Fax Number	:

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

Provider Enumeration Date	:	03/02/2018
Last Update Date	:	03/17/2018

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