Healthcare Provider Details

I. General information

NPI: 1447833264
Provider Name (Legal Business Name): ANA ISABEL ARCHILA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANA CHAVEZ

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 INDEPENDENCE PKWY STE 110
PLANO TX
75023-5472
US

IV. Provider business mailing address

1820 WILLOW LN
PLANO TX
75074-5024
US

V. Phone/Fax

Practice location:
  • Phone: 940-381-1501
  • Fax: 972-424-9117
Mailing address:
  • Phone: 214-723-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14545
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: