Provider Demographics
NPI:1194430819
Name:VILLARREAL, VANESSA MERCEDES (A-GNP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:MERCEDES
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 EMMETT GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6099
Mailing Address - Country:US
Mailing Address - Phone:210-324-0204
Mailing Address - Fax:
Practice Address - Street 1:1831 S GENERAL MCMULLEN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78226-1190
Practice Address - Country:US
Practice Address - Phone:210-644-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1107552363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner