MEDICARE: ANA LICONA 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	AP133654	TX
2	363LF0000X	Family Nurse Practitioner	AP133654	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP133654	OTHER	TX	AANP

General Provider Information

NPI Number	:	1861926289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA LICONA APRN, FNP-C

Provider Business Mailing Address
First Line	:	6510 HILLCROFT AVE STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	139-886-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 HILLCROFT AVE STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	713-988-6677
Fax Number	:

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	08/20/2025

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