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Individual

NIDISH JOSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
AGNP-C

Contact information

Practice address
3044 HIDDEN VALLEY DR, FORT WORTH, TX 76177-2716
(469) 844-7072
(817) 697-4580
Mailing address
3044 HIDDEN VALLEY DR, FORT WORTH, TX 76177-2716

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
789098
TX

Other

Enumeration date
07/13/2017
Last updated
07/30/2021
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