Provider Demographics
NPI:1992581102
Name:CHAVEZ, JOANA KARINA (AGACNP)
Entity type:Individual
Prefix:
First Name:JOANA
Middle Name:KARINA
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:JOANA
Other - Middle Name:KARINA
Other - Last Name:MELLADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5002 N LOOP 1604 E APT 2302
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2409
Mailing Address - Country:US
Mailing Address - Phone:210-605-4595
Mailing Address - Fax:
Practice Address - Street 1:1139 E SONTERRA BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-638-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134389363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care