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General NPI Number Information
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NPI Number | 1992330237
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Entity Type | Individual
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Provider Name | JENNIE T MASABO NP
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Gender | Female
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 4301 BROWN TRL
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City | COLLEYVILLE
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State | TX
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Zip | 76034-3949
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Country | US
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Telephone | 817-281-8275
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Fax | 817-788-8638
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Provider Business Mailing Address
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Address Line | 2737 WAVERLEY DR
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City | TROPHY CLUB
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State | TX
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Zip | 76262-3425
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Country | US
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Telephone | 214-405-3985
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP144983
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 1174604789
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License Number State | TX
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