Provider Demographics
NPI:1841064334
Name:GALLARDO, SEBASTIAN ALEXANDER (RN, BSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:ALEXANDER
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:RN, BSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W AVENUE N
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76909-2601
Mailing Address - Country:US
Mailing Address - Phone:800-946-8627
Mailing Address - Fax:
Practice Address - Street 1:7236 BLUE MOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-8829
Practice Address - Country:US
Practice Address - Phone:173-864-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily