Healthcare Provider Details

I. General information

NPI: 1891377396
Provider Name (Legal Business Name): SAFA ESAM JASSIM NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W MAYFIELD RD STE 101
ARLINGTON TX
76014-2084
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 817-664-4400
  • Fax: 817-664-4414
Mailing address:
  • Phone: 972-997-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1020667
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1020667
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number1020667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: