Healthcare Provider Details

I. General information

NPI: 1538239843
Provider Name (Legal Business Name): ANITA SHARAN JESUDASS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROY RIVERS RD
ELGIN TX
78621-2072
US

IV. Provider business mailing address

10224 FOSSMOOR ST
AUSTIN TX
78717-3822
US

V. Phone/Fax

Practice location:
  • Phone: 737-200-6400
  • Fax: 737-200-6405
Mailing address:
  • Phone: 512-376-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number620618
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP112602
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: