Healthcare Provider Details

I. General information

NPI: 1891292181
Provider Name (Legal Business Name): AMY MICHELLE OLVERA ACAGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MICHELLE APLIN

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 DE ZAVALA RD STE 200
SHAVANO PARK TX
78249-2084
US

IV. Provider business mailing address

4085 DE ZAVALA RD STE 200
SHAVANO PARK TX
78249-2084
US

V. Phone/Fax

Practice location:
  • Phone: 210-558-6288
  • Fax: 210-558-6289
Mailing address:
  • Phone: 210-558-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP135934
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP135934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: