=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902951296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA LYNN JACINTO PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 AMERICAN DR STE 203
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-6190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-398-0734
-----------------------------------------------------
Fax | 972-398-0736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6811 BURNING BUSH
-----------------------------------------------------
City | SACHSE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75048-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-496-0024
-----------------------------------------------------
Fax | 972-398-0736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA01004
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------