Healthcare Provider Details

I. General information

NPI: 1467119040
Provider Name (Legal Business Name): SCARLETT MARIE NERIOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 HARMON RD STE 141
FORT WORTH TX
76177-7602
US

IV. Provider business mailing address

9701 HARMON RD STE 141
FORT WORTH TX
76177-7602
US

V. Phone/Fax

Practice location:
  • Phone: 817-306-5630
  • Fax: 817-306-5631
Mailing address:
  • Phone: 817-306-5630
  • Fax: 817-306-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1059102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: