Provider Demographics
NPI:1982241725
Name:PATLAN, RENEE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PATLAN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 LIONHEART PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1753
Mailing Address - Country:US
Mailing Address - Phone:210-287-6575
Mailing Address - Fax:
Practice Address - Street 1:805 KELLY CREEK RD
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3035
Practice Address - Country:US
Practice Address - Phone:830-980-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142919363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care