Provider Demographics
NPI:1316447204
Name:MITEE, TAANADEEBA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAANADEEBA
Middle Name:
Last Name:MITEE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-4642
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:
Practice Address - Street 1:2909 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4642
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2022014262207Q00000X
TX1086968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine