Most Relevant Information
Provider Data
| NPI Number: | 1003647017 |
| Provider Name: | JENISE GLASS FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 1169905 |
Most Important Dates
| Enumeration Date: | 08/12/2024 |
| Last Updated: | 08/12/2024 |
Provider Practice Location
3308 DEEN RD
FORT WORTH
TX
761066524
Practice Location Phone/Fax
| Phone: | 8177021100 |
| Fax: |
Provider Mailing Location
PO BOX 732973
DALLAS
TX
753732973
Provider Mailing Phone/Fax
| Phone: | 8179185204 |
| Fax: |