Provider Demographics
NPI:1497013635
Name:CHANG, BRENDA LIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LIN
Last Name:CHANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1601 TRINITY ST STE 704F
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:512-324-7871
Mailing Address - Fax:512-324-7870
Practice Address - Street 1:1601 TRINITY ST STE 704F
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-324-7871
Practice Address - Fax:512-324-7870
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296932101Medicaid
TX296932101Medicaid