Provider Demographics
NPI:1184620601
Name:GIOVI, MIROSLAWA JOLANTA (PA-C)
Entity type:Individual
Prefix:
First Name:MIROSLAWA
Middle Name:JOLANTA
Last Name:GIOVI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIROSLAWA
Other - Middle Name:JOLANTA
Other - Last Name:LINDSEY, BODNAR, BORAWSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1600 OAKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-1927
Mailing Address - Country:US
Mailing Address - Phone:940-293-3171
Mailing Address - Fax:
Practice Address - Street 1:1219 OAKLAND STREET
Practice Address - Street 2:TEXAS WOMAN'S UNIVERSITY
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76204-5467
Practice Address - Country:US
Practice Address - Phone:940-898-3555
Practice Address - Fax:940-898-3555
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00240622OtherMEDICARE - RR
PA02800OtherTX LICENSE
NM000F0777Medicaid
TX8J9261OtherPTAN WHEN AT NORTH TEXAS DIABETES & ENDO
TX8N6038OtherBCBS
TX082062301Medicaid
TX8J9261OtherPTAN WHEN AT NORTH TEXAS DIABETES & ENDO
S68338Medicare UPIN
TX8A6064Medicare PIN