Provider Demographics
NPI:1891292181
Name:OLVERA, AMY MICHELLE (ACAGNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:OLVERA
Suffix:
Gender:F
Credentials:ACAGNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:APLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4085 DE ZAVALA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2084
Mailing Address - Country:US
Mailing Address - Phone:210-558-6288
Mailing Address - Fax:
Practice Address - Street 1:4085 DE ZAVALA RD STE 200
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-2084
Practice Address - Country:US
Practice Address - Phone:210-392-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135934363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner