Provider Demographics
NPI:1972040798
Name:PIMENTEL, MITSI DARLENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MITSI
Middle Name:DARLENE
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:MITSI
Other - Middle Name:GUEST
Other - Last Name:PIMENTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4701 BOAT CLUB RD., SUITE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-5285
Mailing Address - Country:US
Mailing Address - Phone:817-237-0515
Mailing Address - Fax:
Practice Address - Street 1:4701 BOAT CLUB RD., SUITE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-5285
Practice Address - Country:US
Practice Address - Phone:817-237-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily