Healthcare Provider Details

I. General information

NPI: 1417407651
Provider Name (Legal Business Name): AASASTAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 ESCARPMENT BLVD SUITE 745, #200
AUSTIN TX
78749-1982
US

IV. Provider business mailing address

9600 ESCARPMENT BLVD SUITE 745, #200
AUSTIN TX
78749-1982
US

V. Phone/Fax

Practice location:
  • Phone: 512-497-4092
  • Fax: 512-280-2207
Mailing address:
  • Phone: 512-497-4092
  • Fax: 512-280-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number621637
License Number StateTX

VIII. Authorized Official

Name: TINA LINSALATA
Title or Position: PRESIDENT
Credential: CRNFA
Phone: 512-497-4092