Individual
STACEY JANTZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2700 E BROAD ST, MANSFIELD, TX 76063-5899
(682) 242-6440
(682) 242-6445
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0391
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1017499
TX
363LA2100X
Acute Care Nurse Practitioner
1017499
TX
Other
Enumeration date
05/17/2021
Last updated
08/09/2021
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