Provider Demographics
NPI:1073930558
Name:SCROGGINS, EUCHARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:EUCHARIA
Middle Name:
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EUCHARIA
Other - Middle Name:
Other - Last Name:OKOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1325 PENNSYLVANIA AVE STE 890
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2145
Mailing Address - Country:US
Mailing Address - Phone:817-250-4280
Mailing Address - Fax:817-250-4281
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 890
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2145
Practice Address - Country:US
Practice Address - Phone:817-250-4280
Practice Address - Fax:817-250-4281
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09018363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX504750YKP5Medicare PIN
TX504750YKQLMedicare PIN