Provider Demographics
NPI:1437800885
Name:F.I.T MEDICAL WEIGHT LOSS & OPTIMIZATION, LLC
Entity Type:Organization
Organization Name:F.I.T MEDICAL WEIGHT LOSS & OPTIMIZATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:281-715-9100
Mailing Address - Street 1:17134 N ELDRIDGE PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17134 N ELDRIDGE PKWY STE B
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8286
Practice Address - Country:US
Practice Address - Phone:281-715-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033558176OtherNPI