Individual
TOMMORA DENICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
7232 NORTH FWY, FORT WORTH, TX 76137-2481
(817) 232-2100
Mailing address
PO BOX 9101, COPPELL, TX 75019-9494
(972) 745-7500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
697480
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
AP119152
TX
Other
Enumeration date
06/04/2010
Last updated
05/14/2015
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