Healthcare Provider Details

I. General information

NPI: 1952116469
Provider Name (Legal Business Name): SHANTAL ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W ARBROOK BLVD STE 101
ARLINGTON TX
76014-3175
US

IV. Provider business mailing address

1218 TEAKWOOD DR
DUNCANVILLE TX
75137-3617
US

V. Phone/Fax

Practice location:
  • Phone: 817-801-1456
  • Fax: 817-801-0594
Mailing address:
  • Phone: 469-826-8104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1190556
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1190556
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: