Provider Demographics
NPI:1285866772
Name:CLANCY-HRNA, ELIZABETH A (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:CLANCY-HRNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:7500 BARLITE BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1361
Mailing Address - Country:US
Mailing Address - Phone:210-921-3939
Mailing Address - Fax:210-921-3941
Practice Address - Street 1:117 DILWORTH PLAZA
Practice Address - Street 2:
Practice Address - City:POTH
Practice Address - State:TX
Practice Address - Zip Code:78147
Practice Address - Country:US
Practice Address - Phone:830-393-1770
Practice Address - Fax:830-393-1775
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01738363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11673580OtherCAQH
TXPA01738OtherLICENSE