Provider Demographics
NPI:1265862197
Name:DAVIS, MARGARET ADELIA (ACNP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ADELIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:HIBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 COLLEGE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3000
Mailing Address - Country:US
Mailing Address - Phone:817-336-6000
Mailing Address - Fax:817-336-2072
Practice Address - Street 1:1521 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2711
Practice Address - Country:US
Practice Address - Phone:817-336-5864
Practice Address - Fax:817-336-2159
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124724363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344936YQFJMedicare PIN