Provider Demographics
NPI:1720566235
Name:SALAZAR, JOSEPHINE ROSE (AGNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:ROSE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15212 SELENE VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4666
Mailing Address - Country:US
Mailing Address - Phone:210-268-8552
Mailing Address - Fax:
Practice Address - Street 1:5282 MEDICAL DR STE 500
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6071
Practice Address - Country:US
Practice Address - Phone:210-526-4784
Practice Address - Fax:210-615-7778
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138154363LP2300X, 208800000X, 363LA2200X, 363LG0600X, 363LW0102X
TX799378163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163WU0100XNursing Service ProvidersRegistered NurseUrology
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty