Healthcare Provider Details

I. General information

NPI: 1356813018
Provider Name (Legal Business Name): NICOLE LEANN FARISH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE LEANN CONE RN

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 DENVER TRL
AZLE TX
76020-3614
US

IV. Provider business mailing address

108 DENVER TRL
AZLE TX
76020-3614
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: