Provider Demographics
NPI:1306295852
Name:MOGENI, JOSEPHINE (FNP)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:MOGENI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 BROADWAY BLVD STE 15
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-3749
Mailing Address - Country:US
Mailing Address - Phone:972-212-4586
Mailing Address - Fax:469-298-0779
Practice Address - Street 1:2940 BROADWAY BLVD STE 15
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3749
Practice Address - Country:US
Practice Address - Phone:972-212-4586
Practice Address - Fax:469-298-0779
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP130436OtherTEXAS STATE BOARD OF NURSING