Provider Demographics
NPI:1033990361
Name:BREZZELL, SILVER (RN)
Entity Type:Individual
Prefix:
First Name:SILVER
Middle Name:
Last Name:BREZZELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 PARK PL AVE STE 110-SHC
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1378
Mailing Address - Country:US
Mailing Address - Phone:817-701-7024
Mailing Address - Fax:
Practice Address - Street 1:1617 PARK PL AVE STE 110-SHC
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1378
Practice Address - Country:US
Practice Address - Phone:817-701-7024
Practice Address - Fax:817-701-7025
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661654163WC1600X, 171400000X, 171M00000X, 251J00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251J00000XAgenciesNursing Care