Provider Demographics
NPI:1124732185
Name:PACK, DENISE ANN (NP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:PACK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:12801 PARKERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5719
Mailing Address - Country:US
Mailing Address - Phone:720-273-1961
Mailing Address - Fax:
Practice Address - Street 1:13140 COIT RD STE 315
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5753
Practice Address - Country:US
Practice Address - Phone:214-272-7829
Practice Address - Fax:972-777-9896
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1105740363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNA