Provider Demographics
NPI:1295243202
Name:HENNON, JANICE MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:HENNON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9910 HUEBNER RD.
Mailing Address - Street 2:SUITE #250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-615-8500
Mailing Address - Fax:210-615-8501
Practice Address - Street 1:9910 HUEBNER RD.
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-615-8500
Practice Address - Fax:210-615-8501
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135319363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner