Provider Demographics
NPI:1639561897
Name:ABBOTT, PATRICIA JOANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOANN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W LOOP 1604 N
Mailing Address - Street 2:APT 8205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3905
Mailing Address - Country:US
Mailing Address - Phone:502-599-7990
Mailing Address - Fax:
Practice Address - Street 1:19284 STONE OAK PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3474
Practice Address - Country:US
Practice Address - Phone:210-268-0156
Practice Address - Fax:210-268-0170
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127516363L00000X, 363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care