Provider Demographics
NPI:1871143560
Name:ROBLES, VENESSA GONZALEZ (AGNP-C)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:GONZALEZ
Last Name:ROBLES
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SHOAL CREEK BLVD STE 130W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1040
Mailing Address - Country:US
Mailing Address - Phone:512-407-8880
Mailing Address - Fax:
Practice Address - Street 1:7800 SHOAL CREEK BLVD STE 130W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1040
Practice Address - Country:US
Practice Address - Phone:512-407-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811769363LF0000X
TXAP142629363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily