Healthcare Provider Details

I. General information

NPI: 1356627996
Provider Name (Legal Business Name): PATRICIA FAGAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W 15TH ST STE 100
PLANO TX
75075
US

IV. Provider business mailing address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax: 562-499-6171
Mailing address:
  • Phone: 562-435-3666
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number598581
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: