Provider Demographics
NPI:1093529554
Name:HARGROVE, PENNI (RN)
Entity type:Individual
Prefix:
First Name:PENNI
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 LORIENT DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2320
Mailing Address - Country:US
Mailing Address - Phone:469-491-7705
Mailing Address - Fax:
Practice Address - Street 1:2004 LORIENT DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2320
Practice Address - Country:US
Practice Address - Phone:469-491-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX941230163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency