Provider Demographics
NPI:1982267621
Name:AGBADIBA, GLORIA NKEM (FNP-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:NKEM
Last Name:AGBADIBA
Suffix:
Gender:F
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 1:1037 KORY DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6979
Mailing Address - Country:US
Mailing Address - Phone:214-727-8831
Mailing Address - Fax:
Practice Address - Street 1:1037 KORY DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6979
Practice Address - Country:US
Practice Address - Phone:214-727-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily