Provider Demographics
NPI:1518997121
Name:CARDENAS, JO ANN (ANP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8645
Mailing Address - Country:US
Mailing Address - Phone:512-397-3360
Mailing Address - Fax:512-343-7107
Practice Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8645
Practice Address - Country:US
Practice Address - Phone:512-397-3360
Practice Address - Fax:512-343-7107
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107209363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154417303Medicaid
TX8N9837OtherBCBS
TX154417301Medicaid
TX147297902Medicaid
TX1544173-07Medicaid
TX154417301Medicaid
TX8G4602Medicare PIN
TX154417303Medicaid
TXTXB149641Medicare UPIN
TX8G3584Medicare PIN