Healthcare Provider Details

I. General information

NPI: 1205806106
Provider Name (Legal Business Name): TARRANT FAMILY PRACTICE P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 BOAT CLUB RD SUITE 800
FORT WORTH TX
76135-7003
US

IV. Provider business mailing address

251 WESTPARK WAY SUITE 200
EULESS TX
76040-3742
US

V. Phone/Fax

Practice location:
  • Phone: 817-237-0515
  • Fax:
Mailing address:
  • Phone: 682-236-3622
  • Fax: 817-545-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS BRIDGETT ANDERSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 682-236-3622