MEDICARE: TRENAY JACKSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1191546	TX

General Provider Information

NPI Number	:	1679379028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENAY JACKSON APRN

Provider Business Mailing Address
First Line	:	11408 SQUALL HILL DR
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-1386
Country	:	US
Telephone Number	:	682-559-0693
Fax Number	:

Provider Business Practice Location Address
First Line	:	8712 MEDICAL CITY WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2414
Country	:	US
Telephone Number	:	817-900-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	04/08/2025

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