Healthcare Provider Details

I. General information

NPI: 1750123089
Provider Name (Legal Business Name): TIJANA NESKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W FM 544 STE 204
MURPHY TX
75094-4628
US

IV. Provider business mailing address

10427 LAKE GARDENS DR
DALLAS TX
75218-3074
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-2100
  • Fax:
Mailing address:
  • Phone: 214-577-8418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1170668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: