Provider Demographics
NPI:1497357578
Name:MADU, JACINTA CHINENYE (APRN-CNP PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:CHINENYE
Last Name:MADU
Suffix:
Gender:F
Credentials:APRN-CNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2072 ROYAL ACRES TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-8772
Mailing Address - Country:US
Mailing Address - Phone:972-824-7874
Mailing Address - Fax:
Practice Address - Street 1:2072 ROYAL ACRES TRL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-8772
Practice Address - Country:US
Practice Address - Phone:972-824-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019465363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health