MEDICARE: LARA CLINE F.N.P.

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	604132	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861437790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA CLINE F.N.P.

Provider Business Mailing Address
First Line	:	2705 FAXON DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-5173
Country	:	US
Telephone Number	:	972-571-7449
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 FAXON DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-5173
Country	:	US
Telephone Number	:	972-571-7449
Fax Number	:

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/31/2023

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Directions to “ LARA CLINE F.N.P.” Practice Location

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