Healthcare Provider Details

I. General information

NPI: 1043416803
Provider Name (Legal Business Name): PATRICIA ANN GROW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD 2240 GULF FREEWAY SOUTH, SU 2.110 LEAGUE CITY TX 77573
GALVESTON TX
77555-0737
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-1022
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-1700
  • Fax: 281-309-0147
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number536866
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP115067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: