Healthcare Provider Details

I. General information

NPI: 1225726458
Provider Name (Legal Business Name): ANDIE SPIEK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W RANDOL MILL RD
ARLINGTON TX
76012-2507
US

IV. Provider business mailing address

809 W RANDOL MILL RD
ARLINGTON TX
76012-2507
US

V. Phone/Fax

Practice location:
  • Phone: 817-460-0257
  • Fax: 817-548-0607
Mailing address:
  • Phone: 817-460-0257
  • Fax: 817-548-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: