Provider Demographics
NPI:1487052767
Name:STUART, TRICIA (PA)
Entity type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:
Last Name:STUART
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 1:3614 BILL PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-3630
Mailing Address - Country:US
Mailing Address - Phone:512-854-4193
Mailing Address - Fax:512-254-4665
Practice Address - Street 1:3614 BILL PRICE RD
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3630
Practice Address - Country:US
Practice Address - Phone:512-854-4193
Practice Address - Fax:512-254-4665
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09304363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical