Provider Demographics
NPI:1508145152
Name:MINNICK, JOANNE MICHELE (DNP, APRN, ACNP-BC,)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:MICHELE
Last Name:MINNICK
Suffix:
Gender:F
Credentials:DNP, APRN, ACNP-BC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 COOL ROCK
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2998
Mailing Address - Country:US
Mailing Address - Phone:210-332-7618
Mailing Address - Fax:
Practice Address - Street 1:7500 CALLAGHAN RD APT 186
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2830
Practice Address - Country:US
Practice Address - Phone:175-781-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6651524363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care