Provider Demographics
NPI:1629458724
Name:VARUGHESE, JERRIN (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:MR
First Name:JERRIN
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S PLANO RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4505
Mailing Address - Country:US
Mailing Address - Phone:972-231-0011
Mailing Address - Fax:972-231-0022
Practice Address - Street 1:350 S PLANO RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4505
Practice Address - Country:US
Practice Address - Phone:972-231-0011
Practice Address - Fax:972-231-0022
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily