1871979914 NPI number — GABRIELLE ANNA BORENS AGACNP-BC

Table of content: GABRIELLE ANNA BORENS AGACNP-BC (NPI 1871979914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871979914 NPI number — GABRIELLE ANNA BORENS AGACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORENS
Provider First Name:
GABRIELLE
Provider Middle Name:
ANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGACNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
GABRIELLE
Provider Other Middle Name:
ANNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871979914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 797171
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75379-7171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-494-4424
Provider Business Mailing Address Fax Number:
214-494-4423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 PARKWOOD BLVD
Provider Second Line Business Practice Location Address:
STE F100
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-7406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-494-4424
Provider Business Practice Location Address Fax Number:
214-494-4423
Provider Enumeration Date:
07/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  AP128214 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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