Provider Demographics
NPI:1326338542
Name:SMITH, NANCY L (ANP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:2801 S HULEN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1528
Mailing Address - Country:US
Mailing Address - Phone:817-921-2838
Mailing Address - Fax:817-921-2833
Practice Address - Street 1:2801 S HULEN ST STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1528
Practice Address - Country:US
Practice Address - Phone:817-921-2838
Practice Address - Fax:817-921-2833
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619058363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health