Provider Demographics
NPI:1144607565
Name:DUTTA, RESHMI (FNP)
Entity Type:Individual
Prefix:
First Name:RESHMI
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RESHMI
Other - Middle Name:
Other - Last Name:MITRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:8159 PITKIN RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-4958
Mailing Address - Country:US
Mailing Address - Phone:972-977-8388
Mailing Address - Fax:
Practice Address - Street 1:8159 PITKIN RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-4958
Practice Address - Country:US
Practice Address - Phone:972-977-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily