Provider Demographics
NPI:1871179069
Name:JOSEPH, SWAPNA SHIJO (NP)
Entity type:Individual
Prefix:MRS
First Name:SWAPNA
Middle Name:SHIJO
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15026 CRYSTAL BEACH LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-3660
Mailing Address - Country:US
Mailing Address - Phone:267-815-7484
Mailing Address - Fax:
Practice Address - Street 1:15026 CRYSTAL BEACH LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-3660
Practice Address - Country:US
Practice Address - Phone:267-815-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031967363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner