Provider Demographics
NPI:1174051775
Name:ALEXANDER, TIANITA DESHEA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:TIANITA
Middle Name:DESHEA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:TIANITA
Other - Middle Name:DESHEA
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2865 CHURN CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1742 OREGON STREET
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-646-7269
Practice Address - Fax:530-737-7681
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54578363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant