Provider Demographics
NPI:1043416803
Name:GROW, PATRICIA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:GROW
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:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-1022
Mailing Address - Country:US
Mailing Address - Phone:409-747-6240
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:2240 GULF FREEWAY SOUTH, SU 2.110 LEAGUE CITY TX 77573
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0737
Practice Address - Country:US
Practice Address - Phone:832-505-1700
Practice Address - Fax:281-309-0147
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536866363LF0000X
TXAP115067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186049601Medicaid
TX186049601Medicaid
TX8J6451Medicare PIN
TXCI5830Medicare PIN
TXP00453615Medicare PIN