Healthcare Provider Details

I. General information

NPI: 1134862774
Provider Name (Legal Business Name): BRITTANY MAE JAISANKAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY MAE BYRD

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

2 GREENWAY PLZ STE 900
HOUSTON TX
77046-0205
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-4580
  • Fax: 210-704-4520
Mailing address:
  • Phone: 713-798-1750
  • Fax: 713-798-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1064422
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1064422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: