Provider Demographics
NPI:1306847587
Name:WINTERS, TRICIA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:L
Last Name:WINTERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1302
Mailing Address - Country:US
Mailing Address - Phone:512-930-3909
Mailing Address - Fax:
Practice Address - Street 1:1464 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9058
Practice Address - Country:US
Practice Address - Phone:512-260-3376
Practice Address - Fax:512-260-1177
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03782363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP86713Medicare UPIN
8J3550Medicare PIN