Provider Demographics
NPI:1053600346
Name:SMITH, TANYA M (PA-C)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:12377 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3126
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:3050 S 1ST ST STE 209
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3442
Practice Address - Country:US
Practice Address - Phone:214-501-0856
Practice Address - Fax:972-608-7003
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2022-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB121774Medicare PIN
TXTXB121773Medicare PIN
TXTXB121772Medicare PIN