Healthcare Provider Details

I. General information

NPI: 1679331177
Provider Name (Legal Business Name): SPEKKS HEALTHCARE SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 THICKET DR
MANSFIELD TX
76063-5728
US

IV. Provider business mailing address

1002 THICKET DR
MANSFIELD TX
76063-5728
US

V. Phone/Fax

Practice location:
  • Phone: 817-736-0400
  • Fax: 817-225-0009
Mailing address:
  • Phone: 817-736-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARAH ESELE IYOHA
Title or Position: OWNER
Credential: FNP
Phone: 817-736-0400