Provider Demographics
NPI:1558852533
Name:ISSAC, SMITHA (FNP)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:ISSAC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SECRETARIAT LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-4891
Mailing Address - Country:US
Mailing Address - Phone:321-543-0205
Mailing Address - Fax:
Practice Address - Street 1:1038 N CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3301
Practice Address - Country:US
Practice Address - Phone:214-518-6404
Practice Address - Fax:214-518-6403
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily