Provider Demographics
NPI:1720603681
Name:SZEMETT, TIA RENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:RENE
Last Name:SZEMETT
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 1:4052 SUMMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4905
Mailing Address - Country:US
Mailing Address - Phone:972-369-4135
Mailing Address - Fax:
Practice Address - Street 1:2900 W SOUTHLAKE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6778
Practice Address - Country:US
Practice Address - Phone:817-379-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1000010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily