Provider Demographics
NPI:1053887018
Name:GENOSA, BERNADETTE (APRN, AG-ACNP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:GENOSA
Suffix:
Gender:F
Credentials:APRN, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 ESTONIA CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-5015
Mailing Address - Country:US
Mailing Address - Phone:210-253-9955
Mailing Address - Fax:
Practice Address - Street 1:1806 ESTONIA CV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-5015
Practice Address - Country:US
Practice Address - Phone:210-253-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139354363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care