MEDICARE: JENIFER RENA DAVIDSON APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1193388	TX

General Provider Information

NPI Number	:	1316748593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER RENA DAVIDSON APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1704 MALL CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1537
Country	:	US
Telephone Number	:	817-769-9166
Fax Number	:	817-984-7604

Provider Business Practice Location Address
First Line	:	1704 MALL CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1537
Country	:	US
Telephone Number	:	817-769-9166
Fax Number	:	817-984-7604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2025
Last Update Date	:	04/03/2026

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