Healthcare Provider Details

I. General information

NPI: 1619710621
Provider Name (Legal Business Name): ERIN HAYWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST FL 2
FORT WORTH TX
76104
US

IV. Provider business mailing address

200 W MAGNOLIA AVE STE 201
FORT WORTH TX
76104-7657
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3000
  • Fax:
Mailing address:
  • Phone: 817-702-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1020221
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1020221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: