Healthcare Provider Details

I. General information

NPI: 1841904364
Provider Name (Legal Business Name): MAYA AJI APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 W PARKER RD STE 530
PLANO TX
75093-8140
US

IV. Provider business mailing address

4129 KICKAPOO TRL
CARROLLTON TX
75010-2305
US

V. Phone/Fax

Practice location:
  • Phone: 214-778-1075
  • Fax:
Mailing address:
  • Phone: 727-859-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1105315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: