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General NPI Number Information
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NPI Number | 1417808361
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Entity Type | Organization
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Legal Business Name | TVP MEDICAL, PLLC
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 209 SAINT LOUIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-1278
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Country | US
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Telephone | 817-961-1842
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Fax |
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Provider Business Mailing Address
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Address Line | 209 SAINT LOUIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-1278
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Country | US
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Telephone | 817-961-1842
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HAYLEYESUS GULILAT
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Credential | NP
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Telephone | 817-718-0271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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