Provider Demographics
NPI:1275089708
Name:BOBROVNYK, MARIYA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIYA
Middle Name:
Last Name:BOBROVNYK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-485-5889
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:4310 JAMES CASEY ST STE 4A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1120
Practice Address - Country:US
Practice Address - Phone:512-448-4588
Practice Address - Fax:512-445-4511
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant