Provider Demographics
NPI:1508403585
Name:PORTIS, MICHELLE ANN (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANN
Last Name:PORTIS
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 1:25111 REMINGTON OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2903
Mailing Address - Country:US
Mailing Address - Phone:210-364-3338
Mailing Address - Fax:
Practice Address - Street 1:1314 E SONTERRA BLVD STE 5102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4289
Practice Address - Country:US
Practice Address - Phone:210-490-8888
Practice Address - Fax:210-496-6865
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144279363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics