Healthcare Provider Details

I. General information

NPI: 1669771887
Provider Name (Legal Business Name): NJUGGIE WA NDEERE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 FLOYD CURL DR
SAN ANTONIO TX
78229-3902
US

IV. Provider business mailing address

7970 FREDERICKSBURG RD APT 101-62
SAN ANTONIO TX
78229-3890
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-4000
  • Fax:
Mailing address:
  • Phone: 513-652-7824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1116828
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1116828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: