MEDICARE: SHIBBI ALEXANDER AGACNP, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP137092	TX

General Provider Information

NPI Number	:	1639673551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIBBI ALEXANDER AGACNP, FNP

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7208
Country	:	US
Telephone Number	:	214-645-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 INWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-3223
Country	:	US
Telephone Number	:	214-645-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	02/06/2020

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