Provider Demographics
NPI:1811549959
Name:BOSS, REBECCA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:BOSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ELIZABETH
Other - Last Name:BORDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3535 VICTORY GROUP WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6721
Mailing Address - Country:US
Mailing Address - Phone:972-712-5100
Mailing Address - Fax:
Practice Address - Street 1:3535 VICTORY GROUP WAY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6721
Practice Address - Country:US
Practice Address - Phone:972-712-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA12947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant