MEDICARE: ANA LUISA HEYDARI 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	AP135401	TX

General Provider Information

NPI Number	:	1740792480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA LUISA HEYDARI FNP

Provider Business Mailing Address
First Line	:	919 HIDDEN RDG
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3813
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-0996

Provider Business Practice Location Address
First Line	:	2120 S WAYSIDE DR STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3900
Country	:	US
Telephone Number	:	713-803-1840
Fax Number	:	713-926-5852

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

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	11/03/2017

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