Provider Demographics
NPI:1922706969
Name:HARGROVE, JYOTI PAI (NP)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:PAI
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 MARKET CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3914
Mailing Address - Country:US
Mailing Address - Phone:281-799-3226
Mailing Address - Fax:
Practice Address - Street 1:1611 N BELT LINE RD STE C
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1792
Practice Address - Country:US
Practice Address - Phone:972-288-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1093929363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health