Provider Demographics
NPI:1043966211
Name:HAMNER, SILVA MARINEZ (PA)
Entity Type:Individual
Prefix:
First Name:SILVA
Middle Name:MARINEZ
Last Name:HAMNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SILVA
Other - Middle Name:MARINEZ
Other - Last Name:TIDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 N INTERSTATE 35 STE 200
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2901
Mailing Address - Country:US
Mailing Address - Phone:512-964-6992
Mailing Address - Fax:
Practice Address - Street 1:1717 N INTERSTATE 35 STE 200
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2901
Practice Address - Country:US
Practice Address - Phone:512-964-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant