Provider Demographics
NPI:1477125821
Name:PLACE, MICHAELA ELIZABETH (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ELIZABETH
Last Name:PLACE
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-9293
Mailing Address - Country:US
Mailing Address - Phone:817-269-0904
Mailing Address - Fax:
Practice Address - Street 1:5232 COLLEYVILLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7827
Practice Address - Country:US
Practice Address - Phone:817-912-9920
Practice Address - Fax:817-912-9964
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX880130163WE0003X
TX1073962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency