Provider Demographics
NPI:1922378025
Name:SISK, TARENA JO (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:TARENA
Middle Name:JO
Last Name:SISK
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 HENNEMAN WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2914
Mailing Address - Country:US
Mailing Address - Phone:214-544-6600
Mailing Address - Fax:620-301-1357
Practice Address - Street 1:7900 HENNEMAN WAY STE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2906
Practice Address - Country:US
Practice Address - Phone:214-554-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2500001367A00000X
TX1074958367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife