Healthcare Provider Details

I. General information

NPI: 1447500145
Provider Name (Legal Business Name): JILL M LUBBE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SANTA FE DR
WEATHERFORD TX
76086-5864
US

IV. Provider business mailing address

800 W MAGNOLIA AVE
FORT WORTH TX
76104-4611
US

V. Phone/Fax

Practice location:
  • Phone: 817-596-0637
  • Fax: 817-596-5143
Mailing address:
  • Phone: 817-759-7000
  • Fax: 817-759-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number741969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: