Provider Demographics
NPI:1366443822
Name:DISNARD, GERALDINE M (MSN MPH RNC PMHNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:M
Last Name:DISNARD
Suffix:
Gender:F
Credentials:MSN MPH RNC PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 FORT WORTH HWY
Mailing Address - Street 2:# 200
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8720
Mailing Address - Country:US
Mailing Address - Phone:817-694-4978
Mailing Address - Fax:817-448-9088
Practice Address - Street 1:3115 FORT WORTH HWY
Practice Address - Street 2:# 200
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-8720
Practice Address - Country:US
Practice Address - Phone:817-694-4978
Practice Address - Fax:817-448-9088
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235929 (PMHNP)363L00000X
FLARNP 9274840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366443822OtherNPI
FL1467694935OtherNPI
TX1366443822OtherNPI
FL1467694935OtherNPI