Provider Demographics
NPI:1700887130
Name:SPURGIN, DEANIE (FNP)
Entity Type:Individual
Prefix:
First Name:DEANIE
Middle Name:
Last Name:SPURGIN
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 1:3801 WILLIAM D TATE AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8757
Mailing Address - Country:US
Mailing Address - Phone:817-310-3070
Mailing Address - Fax:817-310-0023
Practice Address - Street 1:3801 WILLIAM D TATE AVE STE 850
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8757
Practice Address - Country:US
Practice Address - Phone:817-310-3070
Practice Address - Fax:817-310-0023
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205066802Medicaid
TX205066803Medicaid
TX205066801Medicaid
TX205066803Medicaid
TX8L18629Medicare PIN
TX205066801Medicaid
TX8L18628Medicare PIN