Individual
CLARA FORMUSOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1300 W TERRELL AVE STE K230, FORT WORTH, TX 76104-2820
(817) 250-4906
(817) 250-1815
Mailing address
1300 W TERRELL AVE STE K230, FORT WORTH, TX 76104-2820
(817) 250-4906
(817) 250-1815
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP127181
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343075301
—
TX
Enumeration date
01/07/2015
Last updated
02/17/2016
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