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General NPI Number Information
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NPI Number | 1952944654
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Entity Type | Individual
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Provider Name | TERESITA MANIGBAS IDEA RN
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Gender | Female
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 6606 LBJ FWY STE 200
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City | DALLAS
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State | TX
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Zip | 75240-6524
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Country | US
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Telephone | 972-715-5000
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Fax | 972-715-9976
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Provider Business Mailing Address
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Address Line | PO BOX 840853
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City | DALLAS
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State | TX
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Zip | 75284-4000
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Country | US
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Telephone | 972-233-1999
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Fax | 972-233-3666
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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 | AP143989
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 453710
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP143989
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License Number State | TX
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