Healthcare Provider Details

I. General information

NPI: 1073613386
Provider Name (Legal Business Name): AIMEE CARLSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 MEDICAL DR STE 550
SAN ANTONIO TX
78229-3755
US

IV. Provider business mailing address

4410 MEDICAL DR STE 550
SAN ANTONIO TX
78229-3755
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-2222
  • Fax:
Mailing address:
  • Phone: 210-575-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP112865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: