Provider Demographics
NPI:1679906077
Name:SALAZAR, JESSICA LYNN (APRN - FNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:APRN - FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E SONTERRA BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4352
Mailing Address - Country:US
Mailing Address - Phone:210-404-0000
Mailing Address - Fax:210-404-2812
Practice Address - Street 1:1139 E SONTERRA BLVD
Practice Address - Street 2:#405
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-404-0000
Practice Address - Fax:210-404-2812
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX733196363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328346701Medicaid
TXP01297191OtherRAILROAD MEDICARE PTAN
TX8293NDOtherBCBSTX
TX8293NDOtherBCBSTX