MEDICARE: TIFFANIE BRASHEAR VILLASANA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA04765	TX

General Provider Information

NPI Number	:	1922216407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANIE BRASHEAR VILLASANA PA

Provider Business Mailing Address
First Line	:	9235 KATY FWY STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1507
Country	:	US
Telephone Number	:	713-468-5009
Fax Number	:	713-468-4012

Provider Business Practice Location Address
First Line	:	9055 KATY FWY STE 306
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1630
Country	:	US
Telephone Number	:	713-468-5009
Fax Number	:	713-468-4012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	01/15/2019

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