Healthcare Provider Details

I. General information

NPI: 1265862197
Provider Name (Legal Business Name): MARGARET ADELIA DAVIS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET HIBBARD

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 COOPER ST
FORT WORTH TX
76104-2711
US

IV. Provider business mailing address

1001 COLLEGE AVE STE A
FORT WORTH TX
76104-3000
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-5864
  • Fax: 817-336-2159
Mailing address:
  • Phone: 817-336-6000
  • Fax: 817-336-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP124724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: