Individual
ANJAE TARAY HOLDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1759 BROAD PARK CIR S STE 201, MANSFIELD, TX 76063-7834
(682) 341-3910
Mailing address
1101 MIRAMAR AVE, DESOTO, TX 75115-4816
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1174771
TX
Other
Enumeration date
12/06/2024
Last updated
12/06/2024
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