Provider Demographics
NPI:1760510903
Name:SWINGLE, CLINTON JAY (ANP)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:JAY
Last Name:SWINGLE
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 DORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5969
Mailing Address - Country:US
Mailing Address - Phone:214-320-1789
Mailing Address - Fax:
Practice Address - Street 1:221 W COLORADO BLVD STE 640
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2345
Practice Address - Country:US
Practice Address - Phone:214-946-4535
Practice Address - Fax:214-943-8213
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308506363LF0000X
TX607104363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168792301Medicaid
TX8N7698OtherBCBS
TX8N7698OtherBCBS