Provider Demographics
NPI:1265040844
Name:MENDOZA, ASHLEY (FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11806 PLOVER PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-4457
Mailing Address - Country:US
Mailing Address - Phone:210-269-6142
Mailing Address - Fax:
Practice Address - Street 1:8401 DATAPOINT DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5925
Practice Address - Country:US
Practice Address - Phone:210-348-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2021-03-31
Deactivation Date:2020-07-28
Deactivation Code:
Reactivation Date:2020-08-11
Provider Licenses
StateLicense IDTaxonomies
TXAP144740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily