Healthcare Provider Details

I. General information

NPI: 1003299306
Provider Name (Legal Business Name): ELISSA FLORES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 SE MILITARY DR STE 117
SAN ANTONIO TX
78214-2876
US

IV. Provider business mailing address

1131 SE MILITARY DR STE 117
SAN ANTONIO TX
78214-2876
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-8146
  • Fax: 210-675-9508
Mailing address:
  • Phone: 210-924-8146
  • Fax: 210-675-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: