Healthcare Provider Details

I. General information

NPI: 1275786576
Provider Name (Legal Business Name): DEBBY LOUISE POLOZECK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12590 FM 2331
GODLEY TX
76044-3319
US

IV. Provider business mailing address

1017 12TH AVE
FORT WORTH TX
76104-3915
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-7285
  • Fax:
Mailing address:
  • Phone: 817-334-2800
  • Fax: 817-820-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693242
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: