Healthcare Provider Details

I. General information

NPI: 1811383805
Provider Name (Legal Business Name): ZARINA JIWA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SPRINGRIDGE LN
EULESS TX
76039-8031
US

IV. Provider business mailing address

109 SPRINGRIDGE LN
EULESS TX
76039-8031
US

V. Phone/Fax

Practice location:
  • Phone: 817-929-4258
  • Fax: 972-812-1289
Mailing address:
  • Phone: 817-929-4258
  • Fax: 972-812-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number695832
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number695832
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number695832
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: