Healthcare Provider Details

I. General information

NPI: 1265264139
Provider Name (Legal Business Name): AMYNAH JUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 COIT RD
FRISCO TX
75035-0500
US

IV. Provider business mailing address

2367 STOCKTON LN
FRISCO TX
75036-7875
US

V. Phone/Fax

Practice location:
  • Phone: 972-731-9299
  • Fax:
Mailing address:
  • Phone: 513-290-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1171226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: