Provider Demographics
NPI:1588601827
Name:BRITZ, TRUDY POOR (FNP)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:POOR
Last Name:BRITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 RAMPART
Mailing Address - Street 2:
Mailing Address - City:LEAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:77575
Mailing Address - Country:US
Mailing Address - Phone:281-332-2018
Mailing Address - Fax:281-332-2018
Practice Address - Street 1:1807 RAMPART
Practice Address - Street 2:
Practice Address - City:LEAGUE
Practice Address - State:TX
Practice Address - Zip Code:77575
Practice Address - Country:US
Practice Address - Phone:281-332-2018
Practice Address - Fax:281-332-2018
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX437698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18926803Medicaid
TX018926802Medicaid
TX18926803Medicaid
TX018926802Medicaid
TXQ64235Medicare UPIN
TX8G6575Medicare PIN