Provider Demographics
NPI:1922216407
Name:VILLASANA, TIFFANIE BRASHEAR (PA)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:BRASHEAR
Last Name:VILLASANA
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 1:9235 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1507
Mailing Address - Country:US
Mailing Address - Phone:713-468-5009
Mailing Address - Fax:713-468-4012
Practice Address - Street 1:9055 KATY FWY STE 306
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1630
Practice Address - Country:US
Practice Address - Phone:713-468-5009
Practice Address - Fax:713-468-4012
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04765OtherPA LICENSE #