Provider Demographics
NPI:1174853154
Name:NASH, MICHELLE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:NASH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CHASE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-336-7191
Mailing Address - Fax:817-877-4015
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-336-7191
Practice Address - Fax:817-820-0240
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148424363LF0000X
TX836228363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322603YNGSMedicare PIN