MEDICARE: CLINTON JAY SWINGLE ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	308506	NY
2	363LA2200X	Adult Health Nurse Practitioner	607104	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8N7698	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1760510903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON JAY SWINGLE ANP

Provider Business Mailing Address
First Line	:	2674 DORRINGTON DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5969
Country	:	US
Telephone Number	:	214-320-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD STE 640
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2345
Country	:	US
Telephone Number	:	214-946-4535
Fax Number	:	214-943-8213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	06/30/2023

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Directions to “ CLINTON JAY SWINGLE ANP” Practice Location

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