Healthcare Provider Details

I. General information

NPI: 1063750719
Provider Name (Legal Business Name): TAMRA DEE SRIANANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TAMRA DEE WARNER

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 KIRKPATRICK LN
FLOWER MOUND TX
75028-1415
US

IV. Provider business mailing address

5301 S YOSEMITE ST APT 35-103
GREENWOOD VILLAGE CO
80111-3340
US

V. Phone/Fax

Practice location:
  • Phone: 214-513-2300
  • Fax:
Mailing address:
  • Phone: 512-376-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11425
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22804
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006513
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: