Healthcare Provider Details

I. General information

NPI: 1629989793
Provider Name (Legal Business Name): SAFENERVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 CAMP BOWIE BLVD # 114-67
FT WORTH TX
76107-3826
US

IV. Provider business mailing address

4455 CAMP BOWIE BLVD # 114-67
FT WORTH TX
76107-3826
US

V. Phone/Fax

Practice location:
  • Phone: 817-529-8488
  • Fax:
Mailing address:
  • Phone: 817-529-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GINA M SULLIVAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 903-259-0550