Provider Demographics
NPI:1932456209
Name:GEORGE, ELSAMMA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ELSAMMA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 HILLCREST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4226
Mailing Address - Country:US
Mailing Address - Phone:214-812-9795
Mailing Address - Fax:
Practice Address - Street 1:8611 HILLCREST AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4226
Practice Address - Country:US
Practice Address - Phone:214-812-9795
Practice Address - Fax:469-567-3552
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX564019ZTD5Medicare PIN