Healthcare Provider Details

I. General information

NPI: 1578106415
Provider Name (Legal Business Name): HILARY TIPPS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 8TH AVE
FORT WORTH TX
76104-4110
US

IV. Provider business mailing address

4013 MEADOWBROOK DR
FORT WORTH TX
76103-2603
US

V. Phone/Fax

Practice location:
  • Phone: 817-926-2544
  • Fax:
Mailing address:
  • Phone: 323-590-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number882291
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP145057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: