Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Paulina Purnama, PA-C

Individual provider Surgical Physician Assistant · NPI 1275724981

Paulina Purnama, PA-C is a Physician Assistant in Fort Worth, Texas. Qualified in 2007, 19 years ago. Practices with Southlake Orthopedics and Sports Medicine PLLC, a 2-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
19
Licensed in
TX
In the registry since
2007
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

800 12th Ave Ste 200
Fort Worth, TX 76104-2519
Phone: (214) 631-9881
Fax: (469) 482-2526
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1149 Keller Pkwy Ste A, Keller, TX 76248-1620 — (214) 631-9881

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA11021 (TX)

Record details

NPI number1275724981
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 7, 2007
Last updated in NPPESMay 3, 2025
Certification dateMay 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Southlake Orthopedics And Sports Medicine Pllc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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