Provider Demographics
NPI:1366114373
Name:ESPARZA, JUAN ANTONIO (NP)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W KOENIG LN UNIT 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1273
Mailing Address - Country:US
Mailing Address - Phone:512-416-9450
Mailing Address - Fax:
Practice Address - Street 1:101 W KOENIG LN UNIT 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1273
Practice Address - Country:US
Practice Address - Phone:512-416-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155677363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health