Healthcare Provider Details

I. General information

NPI: 1700316296
Provider Name (Legal Business Name): CARENCIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 W RANDOL MILL RD
ARLINGTON TX
76012-3113
US

IV. Provider business mailing address

PO BOX 121592
ARLINGTON TX
76012-1592
US

V. Phone/Fax

Practice location:
  • Phone: 817-478-5333
  • Fax: 682-499-7705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSE TUCKER
Title or Position: OWNER
Credential: PMHNP
Phone: 817-478-5333