Provider Demographics
NPI:1760988919
Name:ST JOHN, CARLENE ARETA (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:ARETA
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 PEDEN RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-5555
Mailing Address - Country:US
Mailing Address - Phone:817-488-6369
Mailing Address - Fax:682-292-8947
Practice Address - Street 1:3348 PEDEN RD STE 401
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-5555
Practice Address - Country:US
Practice Address - Phone:817-488-6369
Practice Address - Fax:682-292-8947
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137633363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily