Provider Demographics
NPI:1952416323
Name:MANSOORI, HOSS (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:HOSS
Middle Name:
Last Name:MANSOORI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 INDEPENDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-9152
Mailing Address - Country:US
Mailing Address - Phone:214-553-5543
Mailing Address - Fax:214-553-5531
Practice Address - Street 1:3100 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-9152
Practice Address - Country:US
Practice Address - Phone:214-553-5543
Practice Address - Fax:214-553-5531
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10190111NI0900X
TXAP130793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX814012460OtherTAX ID