Healthcare Provider Details

I. General information

NPI: 1487454013
Provider Name (Legal Business Name): JEFFREY PASCAL APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

30 GAIT CT
TINTON FALLS NJ
07753-7654
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1192683
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number1192683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: