Healthcare Provider Details

I. General information

NPI: 1265033435
Provider Name (Legal Business Name): ERIC JONATHAN VANCE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/19/2022
Certification Date: 11/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 EWING HALSELL DR STE 270
SAN ANTONIO TX
78229-3725
US

IV. Provider business mailing address

219 ROSE SPOONBILL
SAN ANTONIO TX
78253-6681
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-2828
  • Fax:
Mailing address:
  • Phone: 205-862-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1020833
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: