Provider Demographics
NPI:1790999712
Name:BROSS, ANNETTE RACHEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RACHEL
Last Name:BROSS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:7515 MAIN ST STE 740
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4517
Practice Address - Country:US
Practice Address - Phone:713-795-0202
Practice Address - Fax:713-795-0363
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198256301Medicaid
TX8L3940Medicare PIN
TXP37085Medicare UPIN