Individual
AMANDA MENDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2011 PROSPECT AVE, FORT WORTH, TX 76164-8260
(817) 702-4871
(817) 625-7443
Mailing address
PO BOX 732973, DALLAS, TX 75373-2973
(817) 702-8450
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
668519
TX
363LF0000X
Family Nurse Practitioner
Primary
AP115630
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
668519
TX NP LICENSE
TX
Enumeration date
02/25/2007
Last updated
12/06/2018
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