Provider Demographics
NPI:1053563494
Name:GILLETT, ESTELIZ (DMSC PA-C)
Entity type:Individual
Prefix:DR
First Name:ESTELIZ
Middle Name:
Last Name:GILLETT
Suffix:
Gender:F
Credentials:DMSC PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 S EDMONDS LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6162
Mailing Address - Country:US
Mailing Address - Phone:972-315-8500
Mailing Address - Fax:972-315-8512
Practice Address - Street 1:2141 S EDMONDS LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6162
Practice Address - Country:US
Practice Address - Phone:972-315-8500
Practice Address - Fax:972-315-8512
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L15325Medicare PIN
TX613536/GROUP PTANMedicare PIN