Healthcare Provider Details

I. General information

NPI: 1548412612
Provider Name (Legal Business Name): NICOLA JANE HARCHUT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MEDICAL DR STE 500
SAN ANTONIO TX
78229-3318
US

IV. Provider business mailing address

4330 MEDICAL DR STE 500
SAN ANTONIO TX
78229-3318
US

V. Phone/Fax

Practice location:
  • Phone: 210-732-3668
  • Fax: 210-732-3338
Mailing address:
  • Phone: 210-732-3668
  • Fax: 210-732-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAP117483
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: