Provider Demographics
NPI:1689826364
Name:HENRIC, SAMPREETHI PRISCILLA (PA)
Entity Type:Individual
Prefix:
First Name:SAMPREETHI
Middle Name:PRISCILLA
Last Name:HENRIC
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 1:1110 WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3962
Mailing Address - Country:US
Mailing Address - Phone:214-597-7136
Mailing Address - Fax:
Practice Address - Street 1:1110 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3962
Practice Address - Country:US
Practice Address - Phone:214-597-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant