Provider Demographics
NPI:1780106922
Name:TITHI, HAFIZA R (PA)
Entity type:Individual
Prefix:
First Name:HAFIZA
Middle Name:R
Last Name:TITHI
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 1:157 WALL ST
Mailing Address - Street 2:
Mailing Address - City:TENAHA
Mailing Address - State:TX
Mailing Address - Zip Code:75974-5413
Mailing Address - Country:US
Mailing Address - Phone:936-248-4673
Mailing Address - Fax:
Practice Address - Street 1:157 WALL ST
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-5413
Practice Address - Country:US
Practice Address - Phone:936-248-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant