Healthcare Provider Details

I. General information

NPI: 1801126933
Provider Name (Legal Business Name): CRISTINE MARIE NIZAM ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOSPITAL PKWY HOSPITALCARE ASSOCIATES
BEDFORD TX
76022-6913
US

IV. Provider business mailing address

1600 HOSPITAL PKWY HOSPITALCARE ASSOCIATES
BEDFORD TX
76022-6913
US

V. Phone/Fax

Practice location:
  • Phone: 817-848-2708
  • Fax:
Mailing address:
  • Phone: 817-848-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number680268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: