Healthcare Provider Details

I. General information

NPI: 1851995054
Provider Name (Legal Business Name): NICOLE RENEE ESPURVOA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 HAMILTON WOLFE RD STE 200
SAN ANTONIO TX
78229-3458
US

IV. Provider business mailing address

21303 ENCINO CMNS APT 1305
SAN ANTONIO TX
78259-2230
US

V. Phone/Fax

Practice location:
  • Phone: 210-233-7126
  • Fax:
Mailing address:
  • Phone: 210-519-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number840114
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1028632
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: