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1104348903
NIDISH JOSE
FORT WORTH, TX
NPI
1104348903
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LA2200X Nurse Practitioner, Adult Health
(Licence: TX 789098)
Enumeration Date
2017-07-13
Last Update Date
2021-07-30
Business Address
NIDISH JOSE AGNP-C
3044 HIDDEN VALLEY DR
FORT WORTH, TX 76177-2716
Phone number: 469-844-7072
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Mailing Address
NIDISH JOSE AGNP-C
3044 HIDDEN VALLEY DR
FORT WORTH, TX 76177-2716
Phone number:
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