Provider Demographics
NPI:1972673770
Name:GARCIA, JOSE DOMINGO (FNP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DOMINGO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 CHATAM BERRY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3932
Mailing Address - Country:US
Mailing Address - Phone:512-282-8055
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:11116 CHATAM BERRY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3932
Practice Address - Country:US
Practice Address - Phone:512-282-8055
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ28707Medicare UPIN
TX8J5439Medicare PIN
TX8J5880Medicare PIN
TX8J6969Medicare PIN