Provider Demographics
NPI:1053070300
Name:CASAGRANDE, TANYA PATRICIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:PATRICIA
Last Name:CASAGRANDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:PATRICIA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21309 FOSTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4209
Mailing Address - Country:US
Mailing Address - Phone:281-587-1700
Mailing Address - Fax:
Practice Address - Street 1:21309 FOSTER RD STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4209
Practice Address - Country:US
Practice Address - Phone:281-587-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSTUDENT363A00000X
TXPA15412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA15412OtherTEXAS MEDICAL BOARD