Provider Demographics
NPI:1932910023
Name:BANJARA, GANGA (FNP)
Entity type:Individual
Prefix:
First Name:GANGA
Middle Name:
Last Name:BANJARA
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 1:2329 BUELINGO LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1633
Mailing Address - Country:US
Mailing Address - Phone:467-958-5022
Mailing Address - Fax:
Practice Address - Street 1:7236 BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-4802
Practice Address - Country:US
Practice Address - Phone:817-386-4505
Practice Address - Fax:817-796-1422
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily