Provider Demographics
NPI:1952927113
Name:VILLARREAL, JASMIN PUA (AGACNP)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:PUA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15820 CASSIANO RD
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-9774
Mailing Address - Country:US
Mailing Address - Phone:210-363-7580
Mailing Address - Fax:
Practice Address - Street 1:16620 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2327
Practice Address - Country:US
Practice Address - Phone:210-309-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139976363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care