Provider Demographics
NPI:1053700716
Name:PASSAILAIGUE, ERIN LYNN (APRN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:PASSAILAIGUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2277
Mailing Address - Country:US
Mailing Address - Phone:210-495-9860
Mailing Address - Fax:
Practice Address - Street 1:16977 INTERSTATE 35 N
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1225
Practice Address - Country:US
Practice Address - Phone:210-572-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily