Provider Demographics
NPI:1174983662
Name:ISSAC, BAIJU (FNP)
Entity type:Individual
Prefix:
First Name:BAIJU
Middle Name:
Last Name:ISSAC
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 1:1517 BOSQUE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6428
Mailing Address - Country:US
Mailing Address - Phone:469-579-7172
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6428
Practice Address - Country:US
Practice Address - Phone:214-590-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129628163WX1100X
TX766127163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1100XNursing Service ProvidersRegistered NurseOphthalmic