Healthcare Provider Details

I. General information

NPI: 1407232481
Provider Name (Legal Business Name): ASHA TIJU THARAKAN N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 05/22/2025
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 ALLIANCE BLVD SUITE 700
PLANO TX
75093
US

IV. Provider business mailing address

4716 ALLIANCE BLVD SUITE 700
PLANO TX
75093
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-6000
  • Fax: 469-800-6030
Mailing address:
  • Phone: 469-800-6000
  • Fax: 469-800-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339482-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: