Provider Demographics
NPI:1912615337
Name:JIVAASHANA, PINALBEN GANDHI
Entity Type:Individual
Prefix:
First Name:PINALBEN
Middle Name:GANDHI
Last Name:JIVAASHANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 STONE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-0518
Mailing Address - Country:US
Mailing Address - Phone:817-659-7460
Mailing Address - Fax:
Practice Address - Street 1:5560 MESA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2120
Practice Address - Country:US
Practice Address - Phone:817-292-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098951363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health