Provider Demographics
NPI:1235617887
Name:PRENTICE, STAVROULA EFSTATHIADIS (RPA-C)
Entity type:Individual
Prefix:
First Name:STAVROULA
Middle Name:EFSTATHIADIS
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:STAVROULA
Other - Middle Name:MARIA
Other - Last Name:EFSTATHIADIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:13915 BURNET RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6525
Practice Address - Country:US
Practice Address - Phone:512-220-7002
Practice Address - Fax:844-831-1148
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022310363A00000X
TXPA17409363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant