Provider Demographics
NPI:1649977133
Name:FLORES, JON FREDERICK (A-GNP-C)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:FREDERICK
Last Name:FLORES
Suffix:
Gender:M
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 SWANS XING
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2746
Mailing Address - Country:US
Mailing Address - Phone:210-630-9164
Mailing Address - Fax:
Practice Address - Street 1:9510 SWANS XING
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2746
Practice Address - Country:US
Practice Address - Phone:210-630-9164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1109836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner