Provider Demographics
NPI:1770863805
Name:PASCHAL, JOHN ANDREW (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:PASCHAL
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E COLORADO BLVD APT 702
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1257
Mailing Address - Country:US
Mailing Address - Phone:214-415-0545
Mailing Address - Fax:
Practice Address - Street 1:329 E COLORADO BLVD APT 702
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1257
Practice Address - Country:US
Practice Address - Phone:214-415-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328845803Medicaid
TX328845801Medicaid
TX328845802Medicaid
TX302277YKQLMedicare PIN
TX302277YKPWMedicare PIN
TX328845801Medicaid