Healthcare Provider Details

I. General information

NPI: 1881096709
Provider Name (Legal Business Name): MISTY MARTINEZ TREVINO MSN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY MARTINEZ FNP

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 HIGHWAY 151
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

9011 POTEET JOURDANTON FWY
SAN ANTONIO TX
78224-2124
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9920
  • Fax:
Mailing address:
  • Phone: 210-921-6010
  • Fax: 210-921-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: