Provider Demographics
NPI:1215344924
Name:REZAEE-ANZABI, NAHID (ANP)
Entity type:Individual
Prefix:
First Name:NAHID
Middle Name:
Last Name:REZAEE-ANZABI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 BOOTH CALLOWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8365
Mailing Address - Country:US
Mailing Address - Phone:817-284-3915
Mailing Address - Fax:844-292-1464
Practice Address - Street 1:4375 BOOTH CALLOWAY RD STE 400
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8365
Practice Address - Country:US
Practice Address - Phone:817-284-3915
Practice Address - Fax:844-292-1464
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125548363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344494501Medicaid
TX391014YKP5Medicare PIN