Provider Demographics
NPI:1629853981
Name:GARCIA, MIGUEL ANTONIO (AG-ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 BAUMGARTEN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5416
Mailing Address - Country:US
Mailing Address - Phone:214-683-6373
Mailing Address - Fax:
Practice Address - Street 1:9440 POPPY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3652
Practice Address - Country:US
Practice Address - Phone:214-324-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132377363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care