Healthcare Provider Details

I. General information

NPI: 1699958579
Provider Name (Legal Business Name): PANNABEN H NANGHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 REGENCY PKWY SUITE 125
MANSFIELD TX
76063-5165
US

IV. Provider business mailing address

221 REGENCY PKWY STE 125
MANSFIELD TX
76063-5379
US

V. Phone/Fax

Practice location:
  • Phone: 817-477-5884
  • Fax: 817-453-8091
Mailing address:
  • Phone: 817-634-7670
  • Fax: 833-784-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN8959
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: