Provider Demographics
NPI:1740479153
Name:DESPAULT, TASHA ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:TASHA
Middle Name:ANN
Last Name:DESPAULT
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1305 WONDER WORLD DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7546
Mailing Address - Country:US
Mailing Address - Phone:512-754-8676
Mailing Address - Fax:512-371-6891
Practice Address - Street 1:2028 SUNDANCE PKWY
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2750
Practice Address - Country:US
Practice Address - Phone:830-609-1933
Practice Address - Fax:512-371-6891
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2024-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05466363A00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant