Provider Demographics
NPI:1689196412
Name:PAGE, PRISCILLA (FNP-C)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WORTH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2042
Mailing Address - Country:US
Mailing Address - Phone:469-800-7180
Mailing Address - Fax:
Practice Address - Street 1:3409 WORTH ST STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2042
Practice Address - Country:US
Practice Address - Phone:469-800-7180
Practice Address - Fax:469-800-7190
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily