Provider Demographics
NPI:1952773442
Name:CISNEROS, ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 STONEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7984
Mailing Address - Country:US
Mailing Address - Phone:210-545-9258
Mailing Address - Fax:
Practice Address - Street 1:7005 MIRA LOMA LN
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1411
Practice Address - Country:US
Practice Address - Phone:512-843-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521564163W00000X
TXAP129533363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse