Healthcare Provider Details

I. General information

NPI: 1932687688
Provider Name (Legal Business Name): TANNIA REYNA HEWLETT RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 EASTPARK DR
RICHARDSON TX
75081-5429
US

IV. Provider business mailing address

PO BOX 938
ROWLETT TX
75030-0938
US

V. Phone/Fax

Practice location:
  • Phone: 214-616-1328
  • Fax:
Mailing address:
  • Phone: 214-616-1328
  • Fax: 214-699-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number893486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: