Provider Demographics
NPI:1265704555
Name:JIMENEZ-DAVILA, ALEXIS (FNP-BC, MSN)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:JIMENEZ-DAVILA
Suffix:
Gender:F
Credentials:FNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2208
Mailing Address - Country:US
Mailing Address - Phone:210-546-1400
Mailing Address - Fax:210-546-1449
Practice Address - Street 1:5364 FREDERICKSBURG RD
Practice Address - Street 2:BLDG D STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6188
Practice Address - Country:US
Practice Address - Phone:210-447-4333
Practice Address - Fax:210-447-4330
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX746303363LF0000X
TXAP121448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157327OtherMEDICARE PTAN
TX3048597-01Medicaid