Healthcare Provider Details

I. General information

NPI: 1821720277
Provider Name (Legal Business Name): JAZMINE CARRILLO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 HIGHWAY 151 STE 180
SAN ANTONIO TX
78251-4551
US

IV. Provider business mailing address

7909 FREDERICKSBURG RD STE 110
SAN ANTONIO TX
78229-3400
US

V. Phone/Fax

Practice location:
  • Phone: 210-521-7333
  • Fax: 210-679-3735
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1005538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: