Provider Demographics
NPI:1669369799
Name:SALAZAR-EVANS, DESTINEE RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:RENEE
Last Name:SALAZAR-EVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DESTINEE
Other - Middle Name:RENEE
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4521 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4521 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4039
Practice Address - Country:US
Practice Address - Phone:972-249-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant