Provider Demographics
NPI:1992012694
Name:GILL, TRICIA
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BEACHVIEW ST
Mailing Address - Street 2:APT. # 2301
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3609
Mailing Address - Country:US
Mailing Address - Phone:940-597-3324
Mailing Address - Fax:
Practice Address - Street 1:1121 BEACHVIEW ST
Practice Address - Street 2:APT. # 2301
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3609
Practice Address - Country:US
Practice Address - Phone:940-597-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183393171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor