Provider Demographics
NPI:1568789865
Name:GEORGE, SEEMA MOTTACKAL (FNP)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:MOTTACKAL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SEEMA
Other - Middle Name:
Other - Last Name:SKARIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 DEER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-3204
Mailing Address - Country:US
Mailing Address - Phone:972-463-6326
Mailing Address - Fax:
Practice Address - Street 1:2698 N GALLOWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6389
Practice Address - Country:US
Practice Address - Phone:972-285-4141
Practice Address - Fax:972-270-7320
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX446035YKQLMedicare PIN
TX446035YKP5Medicare PIN