Provider Demographics
NPI:1750836441
Name:GORDON, MONICA (AGNP-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N MACARTHUR BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3611
Mailing Address - Country:US
Mailing Address - Phone:972-607-2340
Mailing Address - Fax:972-607-2347
Practice Address - Street 1:3501 N MACARTHUR BLVD STE 330
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-607-2340
Practice Address - Fax:972-607-2347
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131536363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP131536OtherLICENSE