MEDICARE: NINA TUTU RICO APRN, 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	363L00000X	Nurse Practitioner	AP142118	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP142118	OTHER	TX	ANP LICENSE
2	841610	OTHER	TX	NURSES LICENSE

General Provider Information

NPI Number	:	1770141541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA TUTU RICO APRN, FNP-C

Provider Business Mailing Address
First Line	:	2701 MATLOCK RD STE 103
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2529
Country	:	US
Telephone Number	:	817-795-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 MATLOCK RD STE 103
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2529
Country	:	US
Telephone Number	:	817-795-8346
Fax Number	:

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/30/2025

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