Provider Demographics
NPI:1467948414
Name:SOLIS, INGRID G (PA-C)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:G
Last Name:SOLIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:G
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S CLAY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5771
Mailing Address - Country:US
Mailing Address - Phone:972-875-5220
Mailing Address - Fax:972-875-5606
Practice Address - Street 1:601 S CLAY ST STE 101
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5771
Practice Address - Country:US
Practice Address - Phone:972-875-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical