Provider Demographics
NPI:1053003764
Name:ISLA, BERNARDO NOCUM JR (FNP-C)
Entity type:Individual
Prefix:MR
First Name:BERNARDO
Middle Name:NOCUM
Last Name:ISLA
Suffix:JR
Gender:M
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 1:2209 ELYSIAN TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4112
Mailing Address - Country:US
Mailing Address - Phone:210-724-3049
Mailing Address - Fax:
Practice Address - Street 1:2209 ELYSIAN TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4112
Practice Address - Country:US
Practice Address - Phone:210-724-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily