Provider Demographics
NPI:1730257403
Name:BJORKMAN, CAROL A (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BJORKMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 HARRY HINES BLVD.
Mailing Address - Street 2:PROFESSIONAL OFFICE BUILDING 2, SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-5688
Mailing Address - Country:US
Mailing Address - Phone:214-645-5505
Mailing Address - Fax:214-645-5639
Practice Address - Street 1:5939 HARRY HINES BLVD.
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING 2, SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-5688
Practice Address - Country:US
Practice Address - Phone:214-645-5505
Practice Address - Fax:214-645-5639
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185568601Medicaid
TX185568603Medicaid
TX185568602Medicaid
TXTXB100420Medicare PIN
TXQ78816Medicare UPIN
TX8J4360Medicare ID - Type Unspecified
TX185568601Medicaid