Provider Demographics
NPI:1164475570
Name:HOSAK, HAILEY PAIGE (PAC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:PAIGE
Last Name:HOSAK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S COIT RD STE 36-320
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5743
Mailing Address - Country:US
Mailing Address - Phone:469-250-1339
Mailing Address - Fax:469-398-8040
Practice Address - Street 1:101 S COIT RD STE 36-320
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5743
Practice Address - Country:US
Practice Address - Phone:469-250-1339
Practice Address - Fax:469-398-8040
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03443363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80130748OtherDPS
TX80130748OtherDPS
TX80130748OtherDPS
Q31198Medicare UPIN
TX8D8722Medicare ID - Type Unspecified