Provider Demographics
NPI:1215767447
Name:PHIPPS, AMBRE RAE (APRN FNP)
Entity type:Individual
Prefix:
First Name:AMBRE
Middle Name:RAE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 TEAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5092
Mailing Address - Country:US
Mailing Address - Phone:817-791-8595
Mailing Address - Fax:
Practice Address - Street 1:517 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2621
Practice Address - Country:US
Practice Address - Phone:469-898-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170336363LF0000X
TX916602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse