Provider Demographics
NPI:1831926518
Name:AGILE PRIVATE ENTERPRISE LLC
Entity type:Organization
Organization Name:AGILE PRIVATE ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAWANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-834-7478
Mailing Address - Street 1:1725 BLUE STREAM DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3962
Mailing Address - Country:US
Mailing Address - Phone:469-834-7478
Mailing Address - Fax:469-942-7662
Practice Address - Street 1:1725 BLUE STREAM DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3962
Practice Address - Country:US
Practice Address - Phone:469-834-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service