Healthcare Provider Details

I. General information

NPI: 1811236086
Provider Name (Legal Business Name): JOANNE HILLIARD RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

7511 SHADY HOLLOW LN
SAN ANTONIO TX
78255-1029
US

V. Phone/Fax

Practice location:
  • Phone: 210-296-1239
  • Fax:
Mailing address:
  • Phone: 210-296-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP123955
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number663740
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: