Provider Demographics
NPI:1699806828
Name:SPROUT, JANIS (ANP, GNP)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:SPROUT
Suffix:
Gender:F
Credentials:ANP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WEST MAGNOLIA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-870-7300
Mailing Address - Fax:817-332-8372
Practice Address - Street 1:900 WEST MAGNOLIA AVE
Practice Address - Street 2:STE. 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-332-8372
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248840363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX248840OtherLICENSE
TX83N361Medicare ID - Type Unspecified
TX592338Medicare UPIN