Healthcare Provider Details

I. General information

NPI: 1750131785
Provider Name (Legal Business Name): CANDICE JABUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N COIT RD STE 2302
MCKINNEY TX
75071-6663
US

IV. Provider business mailing address

913 FREESIA DR
LITTLE ELM TX
75068-4603
US

V. Phone/Fax

Practice location:
  • Phone: 469-290-3208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1141974
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number840240
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: