Provider Demographics
NPI:1467299727
Name:PARDO, ILENE NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:NICOLE
Last Name:PARDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ILENE
Other - Middle Name:NICOLE
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-924-1374
Practice Address - Street 1:9011 POTEET JOURDANTON FWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-2124
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-924-1374
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1170306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program