Provider Demographics
NPI:1245533520
Name:SMITH, ANNA A (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:A
Other - Last Name:PIAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:17051 DALLAS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7105
Mailing Address - Country:US
Mailing Address - Phone:214-888-3900
Mailing Address - Fax:214-888-3901
Practice Address - Street 1:17051 DALLAS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7105
Practice Address - Country:US
Practice Address - Phone:214-506-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07083363A00000X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07083OtherTEXAS LICENSE