Provider Demographics
NPI:1962869990
Name:ANTAKLI, FATMA ESEN (AGNP)
Entity type:Individual
Prefix:
First Name:FATMA
Middle Name:ESEN
Last Name:ANTAKLI
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY STE 302A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6604
Mailing Address - Country:US
Mailing Address - Phone:817-283-6995
Mailing Address - Fax:888-498-3190
Practice Address - Street 1:9239 VISTA WAY
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2451
Practice Address - Country:US
Practice Address - Phone:817-283-6995
Practice Address - Fax:888-498-3190
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP134084207QA0505X
MO2016001674363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology