Provider Demographics
NPI:1356942148
Name:TOTANES, NINA NICOLE (AGACNP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:NICOLE
Last Name:TOTANES
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CLEARBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3436
Mailing Address - Country:US
Mailing Address - Phone:210-464-5105
Mailing Address - Fax:
Practice Address - Street 1:12412 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3255
Practice Address - Country:US
Practice Address - Phone:210-640-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019522363LA2100X, 363L00000X
TX869298363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care