Healthcare Provider Details

I. General information

NPI: 1275921199
Provider Name (Legal Business Name): ANDY HUGHES, RNFA SURGICAL FIRST ASSIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 STOCKTON DR BOX 16160 - FORT WORTH, TX 76162
FORT WORTH TX
76132-5058
US

IV. Provider business mailing address

6404 STOCKTON DR P.O. BOX 16160 - FT.WORTH, TX 76162
FORT WORTH TX
76132-5058
US

V. Phone/Fax

Practice location:
  • Phone: 817-913-4440
  • Fax:
Mailing address:
  • Phone: 817-913-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number716498
License Number StateTX

VIII. Authorized Official

Name: MR. ANDY PAT HUGHES
Title or Position: SURGICAL FIRST ASSISTANT
Credential: RN, BSN, CNOR, RNFA
Phone: 817-913-4440