Individual
JESSICA MICHELLE COUFAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2796
(210) 912-1212
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-6483
(682) 885-3113
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1031341
TX
363LP0200X
Pediatric Nurse Practitioner
1031341
TX
Other
Enumeration date
12/19/2022
Last updated
05/09/2023
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