Provider Demographics
NPI:1083855936
Name:DAVIDSON, TZIETAL GAIL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TZIETAL
Middle Name:GAIL
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1601 E DEBBIE LN
Mailing Address - Street 2:SUITE 2109
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3674
Mailing Address - Country:US
Mailing Address - Phone:817-453-8620
Mailing Address - Fax:817-473-9126
Practice Address - Street 1:1601 E DEBBIE LN
Practice Address - Street 2:SUITE 2109
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3674
Practice Address - Country:US
Practice Address - Phone:817-453-8620
Practice Address - Fax:817-473-9126
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06211363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284676YL8LMedicare PIN