Provider Demographics
NPI:1205879616
Name:NEUGENT, ANNE SPRUANCE (FNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:SPRUANCE
Last Name:NEUGENT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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 1:3410 WORTH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1074
Practice Address - Fax:214-370-1026
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144992802Medicaid
TX144992801Medicaid
TX144992802Medicaid
TX394683YM09Medicare UPIN
TXS65330Medicare UPIN
TX8B9520Medicare PIN
TX500019489Medicare PIN