Provider Demographics
NPI:1992330237
Name:MASABO, JENNIE T (NP)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:T
Last Name:MASABO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2737 WAVERLEY DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3425
Mailing Address - Country:US
Mailing Address - Phone:214-405-3985
Mailing Address - Fax:
Practice Address - Street 1:4301 BROWN TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3949
Practice Address - Country:US
Practice Address - Phone:817-281-8275
Practice Address - Fax:817-788-8638
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP144983363LF0000X
TX1174604789207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology