MEDICARE: DR. JOANNE MICHELE MINNICK DNP, APRN, ACNP-BC,

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	363LA2100X	Acute Care Nurse Practitioner	6651524	TX

General Provider Information

NPI Number	:	1508145152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE MICHELE MINNICK DNP, APRN, ACNP-BC,

Provider Business Mailing Address
First Line	:	134 COOL ROCK
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-2998
Country	:	US
Telephone Number	:	210-332-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 CALLAGHAN RD APT 186
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2830
Country	:	US
Telephone Number	:	175-781-8415
Fax Number	:

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	09/29/2019

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