Healthcare Provider Details

I. General information

NPI: 1477961365
Provider Name (Legal Business Name): AMANDA BROSNAN MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W MARTIN ST
SAN ANTONIO TX
78207-0903
US

IV. Provider business mailing address

903 W MARTIN ST
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3427
  • Fax: 210-358-5940
Mailing address:
  • Phone: 210-358-3427
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: