Provider Demographics
NPI:1144696253
Name:JOSE, SUJA (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUJA
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MYERS MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3711
Mailing Address - Country:US
Mailing Address - Phone:972-240-0012
Mailing Address - Fax:
Practice Address - Street 1:906 MYERS MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3711
Practice Address - Country:US
Practice Address - Phone:972-240-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily