MEDICARE: MRS. MELISSA GRANADOS 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	363LF0000X	Family Nurse Practitioner	AP143560	TX

General Provider Information

NPI Number	:	1790327161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA GRANADOS APRN, FNP-C

Provider Business Mailing Address
First Line	:	12055 RACHEL LEA LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-9150
Country	:	US
Telephone Number	:	940-595-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4203
Country	:	US
Telephone Number	:	817-346-0094
Fax Number	:

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

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	11/08/2024

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