Provider Demographics
NPI:1326143629
Name:SOILEAU, STEPHANIE LEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEE
Last Name:SOILEAU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SOILEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3551 RODGER BROOKE DR
Mailing Address - Street 2:SAN ANTOINIO, TX
Mailing Address - City:SAN ANTONIO
Mailing Address - State:AA
Mailing Address - Zip Code:78219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 RODGER BROOKE DR.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-4431
Practice Address - Country:US
Practice Address - Phone:706-414-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178335701Medicaid
TX178333701Medicaid
TX8C9887Medicare Oscar/Certification
TX178335701Medicaid