MEDICARE: PATRICIA JOANN ABBOTT FNP-C

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	363L00000X	Nurse Practitioner	AP127516	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP127516	TX
3	363LF0000X	Family Nurse Practitioner	AP127516	TX

General Provider Information

NPI Number	:	1639561897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA JOANN ABBOTT FNP-C

Provider Business Mailing Address
First Line	:	3010 W LOOP 1604 N
Second Line	:	APT 8205
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3905
Country	:	US
Telephone Number	:	502-599-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	19284 STONE OAK PKWY STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3474
Country	:	US
Telephone Number	:	210-268-0156
Fax Number	:	210-268-0170

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

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	02/25/2015

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