Provider Demographics
NPI:1972982585
Name:BAHLATZIS, ASHLEY MARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIA
Last Name:BAHLATZIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 N MAIN ST APT O
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-1870
Mailing Address - Country:US
Mailing Address - Phone:607-215-3888
Mailing Address - Fax:
Practice Address - Street 1:1603 N MAIN ST APT O
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1870
Practice Address - Country:US
Practice Address - Phone:607-215-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018305-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical