Provider Demographics
NPI:1245872670
Name:WEGESA, BRONTA LENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:BRONTA
Middle Name:LENISE
Last Name:WEGESA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PARK BEND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5386
Mailing Address - Country:US
Mailing Address - Phone:512-994-4159
Mailing Address - Fax:512-793-9783
Practice Address - Street 1:2200 PARK BEND DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5386
Practice Address - Country:US
Practice Address - Phone:512-994-4159
Practice Address - Fax:512-793-9783
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily