Provider Demographics
NPI:1255094587
Name:SHIJI, ENITAN ADEBAYO (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ENITAN
Middle Name:ADEBAYO
Last Name:SHIJI
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5378
Mailing Address - Country:US
Mailing Address - Phone:214-545-2308
Mailing Address - Fax:
Practice Address - Street 1:3507 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5378
Practice Address - Country:US
Practice Address - Phone:214-545-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40835OtherTEXAS BOARD OF NURSING (PRESCRIPTIVE AUTHORITY)
TX1054626OtherTEXAS BOARD OF NURSING (APRN) LICENSE