Provider Demographics
NPI:1518428366
Name:TIJANI, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:TIJANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 DORIS DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6953
Mailing Address - Country:US
Mailing Address - Phone:214-971-1925
Mailing Address - Fax:214-594-8862
Practice Address - Street 1:1501 DORIS DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6953
Practice Address - Country:US
Practice Address - Phone:214-971-1925
Practice Address - Fax:214-594-8862
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018073251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health