Provider Demographics
NPI:1316246424
Name:TANNA, SONYA AMRATLAL (PA)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:AMRATLAL
Last Name:TANNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 BRYANT IRVIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-820-0011
Mailing Address - Fax:817-820-0073
Practice Address - Street 1:6600 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-820-0011
Practice Address - Fax:817-820-0073
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2838617-02Medicaid
TX2035487-02Medicaid
TX2838617-02Medicaid
TX269240YNVLMedicare PIN
TX2035487-02Medicaid