Provider Demographics
NPI:1992218424
Name:BAINO, SANJU (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SANJU
Middle Name:
Last Name:BAINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SANJU
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8994 TOUR DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2036
Mailing Address - Country:US
Mailing Address - Phone:972-816-8665
Mailing Address - Fax:
Practice Address - Street 1:8994 TOUR DR STE 210
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2036
Practice Address - Country:US
Practice Address - Phone:972-810-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA