Healthcare Provider Details

I. General information

NPI: 1851841266
Provider Name (Legal Business Name): CLARISA G MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARISA G CHAVEZ FNP

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W MARTIN ST
SAN ANTONIO TX
78207-0903
US

IV. Provider business mailing address

903 W MARTIN ST
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-3582
  • Fax: 210-358-3252
Mailing address:
  • Phone: 210-358-3582
  • Fax: 210-358-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: