Provider Demographics
NPI:1205981941
Name:PANTEA, FLORICA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:FLORICA
Middle Name:
Last Name:PANTEA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 BABCOCK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4899
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:
Practice Address - Street 1:2425 BABCOCK RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-616-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304490363LA2200X
NYF340651363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02843194Medicaid
NY02843194Medicaid
NY029XJ1Medicare ID - Type Unspecified