Provider Demographics
NPI:1124536321
Name:DAVILA, MARTHA ANGELICA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANGELICA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 SEQUOIA WOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4253
Mailing Address - Country:US
Mailing Address - Phone:210-696-1984
Mailing Address - Fax:
Practice Address - Street 1:5441 BABCOCK RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-641-1394
Practice Address - Fax:210-641-1394
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily