Provider Demographics
NPI:1568715514
Name:MUGADZA, CHARITY C (NP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:C
Last Name:MUGADZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 FORD RD STE B425
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7248
Mailing Address - Country:US
Mailing Address - Phone:469-687-0039
Mailing Address - Fax:469-687-0039
Practice Address - Street 1:12300 FORD RD STE B425
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7248
Practice Address - Country:US
Practice Address - Phone:469-687-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL172456363LA2100X
TX727383363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX727383OtherLICENSE NUMBER