MEDICARE: VIRGINIA CARRILLO JOHNSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1232731	TX

General Provider Information

NPI Number	:	1275470601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA CARRILLO JOHNSON APRN

Provider Business Mailing Address
First Line	:	1020 NE LOOP 410 STE 700
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1220
Country	:	US
Telephone Number	:	520-366-7534
Fax Number	:	520-366-7534

Provider Business Practice Location Address
First Line	:	1020 NE LOOP 410 STE 700
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1220
Country	:	US
Telephone Number	:	520-366-7534
Fax Number	:	520-366-7534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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