Healthcare Provider Details

I. General information

NPI: 1982848016
Provider Name (Legal Business Name): MARTHA L TREGRE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

IV. Provider business mailing address

PO BOX 975341
DALLAS TX
75397-5341
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-820-4815
Mailing address:
  • Phone: 972-791-1224
  • Fax: 972-819-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number244562
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: