Provider Demographics
NPI:1740892819
Name:CERVANTES, ANGEL ANTONIO (FNP)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANTONIO
Last Name:CERVANTES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 LILY BLAIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6408
Mailing Address - Country:US
Mailing Address - Phone:210-381-0058
Mailing Address - Fax:
Practice Address - Street 1:7031 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1911
Practice Address - Country:US
Practice Address - Phone:210-761-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily