Provider Demographics
NPI:1275786576
Name:POLOZECK, DEBBY LOUISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBBY
Middle Name:LOUISE
Last Name:POLOZECK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3915
Mailing Address - Country:US
Mailing Address - Phone:817-334-2800
Mailing Address - Fax:817-820-0094
Practice Address - Street 1:920 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5488
Practice Address - Country:US
Practice Address - Phone:817-334-2800
Practice Address - Fax:817-820-0094
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128855363LF0000X
TX693242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX446897YKPWMedicare PIN