Provider Demographics
NPI:1235617887
Name:PRENTICE, STAVROULA EFSTATHIADIS (RPA-C)
Entity Type:Individual
Prefix:
First Name:STAVROULA
Middle Name:EFSTATHIADIS
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:STAVROULA
Other - Middle Name:MARIA
Other - Last Name:EFSTATHIADIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 TRINITY ST STE 704D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:512-324-8320
Mailing Address - Fax:512-324-8323
Practice Address - Street 1:1601 TRINITY ST STE 704D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-324-8320
Practice Address - Fax:512-324-8323
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022310363A00000X
TXPA17409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant