Provider Demographics
NPI:1548777295
Name:GARCIA, LOURINE (NP)
Entity type:Individual
Prefix:
First Name:LOURINE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LOURINE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LOURINE STROZYNSKI
Mailing Address - Street 1:1325 PENNSYLVANIA AVE STE 690
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2133
Mailing Address - Country:US
Mailing Address - Phone:817-761-7740
Mailing Address - Fax:817-761-7742
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 690
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2133
Practice Address - Country:US
Practice Address - Phone:817-761-7740
Practice Address - Fax:817-761-7742
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007817A363LA2100X, 363LG0600X
TX1054345363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300011811Medicaid
IN236040271OtherMEDICARE PTAN