MEDICARE: MS. DAYANA NOEMI JACOME AGACNP

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	1061192	TX

General Provider Information

NPI Number	:	1801531470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAYANA NOEMI JACOME AGACNP

Provider Business Mailing Address
First Line	:	6518 HARTWICK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-1412
Country	:	US
Telephone Number	:	713-357-8807
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MEDICAL PARK LN STE A
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-4975
Country	:	US
Telephone Number	:	936-294-0971
Fax Number	:	936-294-0977

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

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	04/28/2022

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