Provider Demographics
NPI:1194785089
Name:RICCI, ELAINA NOEL (PA-C)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:NOEL
Last Name:RICCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-755
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2584
Mailing Address - Country:US
Mailing Address - Phone:972-566-2600
Mailing Address - Fax:972-566-2121
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-755
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2584
Practice Address - Country:US
Practice Address - Phone:972-566-2600
Practice Address - Fax:972-566-2121
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02436363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8201OtherBLUE CROSS
S91319Medicare UPIN