Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 200190 | OK |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP144916 | TX |
NPI | 1053943217 |
---|---|
Provider Name | Joeresty Tabujara Abelida |
First Address | San Antonio, TX 78250-4630 |
Second Address | San Antonio, TX 78250-4630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2020 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP144916 | TEXAS BOARD OF NURSING (01) | TX |