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NPI Code Detail

MEDICARE: GANGA BANJARA FNP

MEDICARE: GANGA BANJARA FNP
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
1363LF0000XFamily Nurse Practitioner1169578TX

General Provider Information

NPI Number : 1932910023
Entity Type Code : Individual
Provider Name (Legal Business Name) : GANGA BANJARA FNP
Provider Business Mailing Address
First Line : 2329 BUELINGO LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76131-1633
Country : US
Telephone Number : 467-958-5022
Fax Number :
Provider Business Practice Location Address
First Line : 7236 BLUE MOUND RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76131-4802
Country : US
Telephone Number : 817-386-4505
Fax Number : 817-796-1422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2025
Last Update Date : 06/10/2025

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Directions to “ GANGA BANJARA FNP” Practice Location

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