Andrea Marie Iltis, ACNPC-AG

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

1038667 Issued in TX

Practice address

8300 Floyd Curl Dr
San Antonio, TX 78229-3931

Phone

(210) 450-9200

Fax

(210) 450-6013

NPI assigned

Jul 24, 2026

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1784851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1689595563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 FLOYD CURL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293931",
            "telephone_number": "210-450-9200",
            "fax_number": "210-450-6013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 FLOYD CURL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293931",
            "telephone_number": "210-450-9200",
            "fax_number": "210-450-6013"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4502 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294402",
            "country_code": "US",
            "telephone_number": "210-358-8900",
            "fax_number": "210-567-5797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILTIS",
        "first_name": "ANDREA",
        "middle_name": "MARIE",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-24",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "1038667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Illuminate Pediatric Therapy, PLLC
• Illuminated Direction LLC
• Illuminating Possibility LLC
• Vidhya Devi Srinivasan Illuri, MD
• Jumoke Ilori
• Joshua Michael Iltis, MD
• Brenda Im, RBT
• Cheongin Im, PHD, MSN, RN
• Joshua Im
• Stephen S. Im, M.D.

• Surgery Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.