Basic Information
Provider Information
NPI: 1003004151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PLETIN
FirstName: TANYA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 845347
Address2:  
City: DALLAS
State: TX
PostalCode: 752845347
CountryCode: US
TelephoneNumber: 2146483916
FaxNumber: 2146488423
Practice Location
Address1: 5323 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 753907208
CountryCode: US
TelephoneNumber: 2146483916
FaxNumber: 2146488423
Other Information
ProviderEnumerationDate: 10/12/2007
LastUpdateDate: 09/16/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA02929TXY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000XPA 02929TXN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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