Provider Demographics
NPI:1619638871
Name:NORTH TEXAS PROVIDER SERVICES, PLLC
Entity Type:Organization
Organization Name:NORTH TEXAS PROVIDER SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NP
Authorized Official - Prefix:
Authorized Official - First Name:ROSETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-892-7339
Mailing Address - Street 1:513 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4576
Mailing Address - Country:US
Mailing Address - Phone:484-892-7339
Mailing Address - Fax:
Practice Address - Street 1:909 EUSTON ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1629
Practice Address - Country:US
Practice Address - Phone:484-892-7339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty