Provider Demographics
NPI:1225897234
Name:GROSS, ERIC CHRISTOPHER (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:GROSS
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15836 MIRASOL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2134
Mailing Address - Country:US
Mailing Address - Phone:972-814-6682
Mailing Address - Fax:
Practice Address - Street 1:15836 MIRASOL DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2134
Practice Address - Country:US
Practice Address - Phone:972-814-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154856363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care