Provider Demographics
NPI:1932127388
Name:BROERMAN, CELESTE ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:ELAINE
Last Name:BROERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1306
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:210-334-2861
Practice Address - Street 1:7219 CULEBRA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:210-334-2861
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343427YKQQMedicare PIN
TXQ70318Medicare UPIN
TX182887301Medicaid
TXQ70318Medicare UPIN