Provider Demographics
NPI:1982217212
Name:ROBINSON, PHYLLIS (APRN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ELK RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2234
Mailing Address - Country:US
Mailing Address - Phone:210-365-3659
Mailing Address - Fax:
Practice Address - Street 1:19016 STONE OAK PKWY STE 190
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3387
Practice Address - Country:US
Practice Address - Phone:210-490-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003217363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty