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General NPI Number Information
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NPI Number | 1285439760
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Entity Type | Individual
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Provider Name | JORDYN GHANEM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 17110 DALLAS PKWY STE 100
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City | DALLAS
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State | TX
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Zip | 75248-1167
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Country | US
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Telephone | 972-380-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 CAPITOL AVE APT 107
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City | DALLAS
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State | TX
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Zip | 75206-6920
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Country | US
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Telephone | 561-856-1310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1179049
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License Number State | TX
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