MEDICARE: JOSIANE OCTAVIUS FNP-BC

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	1105684	TX

General Provider Information

NPI Number	:	1861938607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIANE OCTAVIUS FNP-BC

Provider Business Mailing Address
First Line	:	1000 LEGACY RANCH RD
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-1293
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 LEGACY RANCH RD
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-1293
Country	:	US
Telephone Number	:	877-868-2528
Fax Number	:	877-926-5332

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	10/24/2024

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