Healthcare Provider Details

I. General information

NPI: 1013443696
Provider Name (Legal Business Name): SHEEBA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: N/A N/A FNP

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

PO BOX 732973
DALLAS TX
75373-2973
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3000
  • Fax: 817-927-3814
Mailing address:
  • Phone: 817-702-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133471
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: