Provider Demographics
NPI:1932213402
Name:HAAG, BRIAN KEITH (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:HAAG
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ARBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3175
Mailing Address - Country:US
Mailing Address - Phone:817-276-6850
Mailing Address - Fax:817-861-4501
Practice Address - Street 1:400 W ARBROOK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3175
Practice Address - Country:US
Practice Address - Phone:817-276-6850
Practice Address - Fax:817-861-4501
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184646103Medicaid
TX184646105Medicaid
TX184646107Medicaid
TX184646104Medicaid
TX184646106Medicaid
TX184646107Medicaid
TX184646106Medicaid
TX184646105Medicaid
TX184646104Medicaid
TXTXB112156Medicare PIN
TXTXB112151Medicare PIN