IndividualActive
Mimi Idicula, NP
NPI 1003009580 · Nurse Practitioner · Irving, TX
Provider details
- NPI number
- 1003009580
- Entity type
- Individual
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- License
- 10049 (TX)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Chiropractic Providers
Practice location
6161 N State Highway 161
Irving, TX 75038-2220
Phone: (972) 258-7499
Fax: (972) 257-0897
Approximate (ZIP-level) locationGet directions
Mailing address
6161 N State Highway 161
Irving, TX 75038-2220
Additional practice locations (1)
- 1717 W University Dr#408Mckinney, TX 75069Phone: (972) 548-2600Fax: (972) 548-2610
Registry dates
- Enumerated
- 2007-08-20
- Last updated
- 2021-07-13
- Certified
- 2021-04-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.