MEDICARE: ERIC ABRAHAM ORNELAS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1039125	TX
2	363LF0000X	Family Nurse Practitioner	1039125	TX

General Provider Information

NPI Number	:	1558166611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC ABRAHAM ORNELAS FNP-C

Provider Business Mailing Address
First Line	:	10203 MESA MEDINA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78252-4518
Country	:	US
Telephone Number	:	623-703-7933
Fax Number	:

Provider Business Practice Location Address
First Line	:	12047 POTRANCO RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7555
Country	:	US
Telephone Number	:	210-571-1338
Fax Number	:	210-571-1339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	07/09/2025

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