Provider Demographics
NPI:1275013740
Name:SPEARS, JOANN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MARIE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:MARIE
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4613 SAINT THOMAS PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-1653
Mailing Address - Country:US
Mailing Address - Phone:817-566-6191
Mailing Address - Fax:
Practice Address - Street 1:4613 SAINT THOMAS PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-1653
Practice Address - Country:US
Practice Address - Phone:817-566-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX845991163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse