Provider Demographics
NPI:1598008690
Name:LOSAK, DIANA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:LOSAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4716 ALLIANCE BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5389
Mailing Address - Country:US
Mailing Address - Phone:469-800-6069
Mailing Address - Fax:469-800-6061
Practice Address - Street 1:4716 ALLIANCE BOULEVARD
Practice Address - Street 2:STE 700
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5389
Practice Address - Country:US
Practice Address - Phone:469-800-6069
Practice Address - Fax:214-292-0047
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353899301Medicaid
TX353899301Medicaid