Provider Demographics
NPI:1235950312
Name:NOVOA, JAZMIN LYNNESSA (FNP)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:LYNNESSA
Last Name:NOVOA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JAZMIN
Other - Middle Name:LYNNESSA
Other - Last Name:PURYEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2532
Mailing Address - Country:US
Mailing Address - Phone:817-632-5400
Mailing Address - Fax:
Practice Address - Street 1:3500 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2532
Practice Address - Country:US
Practice Address - Phone:817-632-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily