Provider Demographics
NPI:1730349358
Name:COOVER, SHIRIEN O (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHIRIEN
Middle Name:O
Last Name:COOVER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:720 W 34TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1205
Practice Address - Country:US
Practice Address - Phone:512-450-1001
Practice Address - Fax:512-302-9723
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2023-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730349358OtherINDIVIDUAL NPI
TX742907350OtherTAX ID
TX1518080415OtherNPI OF EMPLOYER