Provider Demographics
NPI:1114494150
Name:QUESADA, NIKKI C (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:C
Last Name:QUESADA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LEAH AVE # B
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7849
Mailing Address - Country:US
Mailing Address - Phone:512-392-1700
Mailing Address - Fax:512-396-8743
Practice Address - Street 1:601 LEAH AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7849
Practice Address - Country:US
Practice Address - Phone:512-392-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000610363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics