Provider Demographics
NPI:1962721779
Name:VEGA, DENISE I (MSN, GNP-BC, ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:VEGA
Suffix:I
Gender:F
Credentials:MSN, GNP-BC, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:4411 MEDICAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3822
Practice Address - Country:US
Practice Address - Phone:210-614-5400
Practice Address - Fax:210-614-2413
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649365363LA2100X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381801YR99OtherMEDICARE
TXP01432253OtherRR MEDICARE
TX342347701Medicaid
TX8095NMOtherBCBS TX