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General NPI Number Information
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NPI Number | 1427489400
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Entity Type | Individual
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Provider Name | BRENDA BOSCH CPNP
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Gender | Female
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1612 5TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4324
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Country | US
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Telephone | 817-759-9255
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Fax |
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Provider Business Mailing Address
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Address Line | 7133 QUAIL RIDGE RD
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City | FORT WORTH
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State | TX
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Zip | 76132-3529
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Country | US
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Telephone | 214-799-9783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP102860
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License Number State | TX
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