{
"Npi": {
"NPI": "1669353843",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "YZAGUIRRE",
"FirstName": "MICAH",
"MiddleName": "JOEL",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "ACNPC-AG",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "148 FABARM LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW BRAUNFELS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78130-5178",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-317-5024",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4458 MEDICAL DR STE 505",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78229-3748",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-690-7400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/11/2025",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LA2100X",
"TaxonomyName": "Acute Care Nurse Practitioner",
"LicenseNumber": "1190385",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LC0200X",
"TaxonomyName": "Critical Care Medicine Nurse Practitioner",
"LicenseNumber": "1190385",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}