Provider Demographics
NPI:1407957913
Name:MUCHA, ADRIENNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:MUCHA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WATERS EDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1300
Mailing Address - Country:US
Mailing Address - Phone:817-408-3600
Mailing Address - Fax:817-408-3699
Practice Address - Street 1:1315 WATERS EDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1300
Practice Address - Country:US
Practice Address - Phone:817-408-3600
Practice Address - Fax:817-408-3699
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547798363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J5043Medicare PIN