Provider Demographics
NPI:1639103112
Name:STRETCH, NANCY GAE (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:GAE
Last Name:STRETCH
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 TELECOM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2203
Mailing Address - Country:US
Mailing Address - Phone:469-800-2100
Mailing Address - Fax:469-800-2310
Practice Address - Street 1:5345 N GEORGE BUSH FWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2767
Practice Address - Country:US
Practice Address - Phone:972-495-5888
Practice Address - Fax:972-495-0588
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX548592363L00000X, 363LF0000X
TXAP111174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1515074-02Medicaid
TXP48628Medicare UPIN
TX8B9185Medicare PIN