Provider Demographics
NPI:1356318380
Name:CAMARATA, CAROLINE (PA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CAMARATA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 CYPRESS STATION DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3002
Mailing Address - Country:US
Mailing Address - Phone:281-440-5300
Mailing Address - Fax:832-232-5501
Practice Address - Street 1:1140 CYPRESS STATION DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3002
Practice Address - Country:US
Practice Address - Phone:281-440-5300
Practice Address - Fax:832-232-5501
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01778363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N719Medicare PIN
TX81N463Medicare PIN
TXS55636Medicare UPIN