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General NPI Number Information
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NPI Number | 1730903022
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Entity Type | Individual
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Provider Name | ANTIONETTE GROVE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 540 MADISON OAK DR STE 310
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3921
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Country | US
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Telephone | 210-657-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 540 MADISON OAK DR STE 310
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3921
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Country | US
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Telephone | 210-657-2100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1179901
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1179901
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1179901
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License Number State | TX
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