Healthcare Provider Details

I. General information

NPI: 1669136099
Provider Name (Legal Business Name): AMBER NICHOLE CASAREZ APRN AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 BLANCO RD STE 102
SAN ANTONIO TX
78216-6678
US

IV. Provider business mailing address

143 CATTLE DR
CASTROVILLE TX
78009-6006
US

V. Phone/Fax

Practice location:
  • Phone: 210-239-9897
  • Fax:
Mailing address:
  • Phone: 210-606-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1057301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: