Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Daniel Ethridge, PA

Individual provider Physician Assistant · NPI 1104301852

Jacob Daniel Ethridge, PA is a Physician Assistant in San Antonio, Texas. Qualified in 2018, 8 years ago. Practices with Nluc PLLC, a 222-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
8
Licensed in
TX
In the registry since
2018
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1150 N Loop 1604 W Ste 150
San Antonio, TX 78248-4505
Phone: (281) 783-8162
Fax: (713) 439-7995
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 5282 Medical Dr Ste 250, San Antonio, TX 78229-6039 — (210) 341-9614
  • 10423 State Highway 151 Ste 101, San Antonio, TX 78251-4768 — (210) 341-9614

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA12348 (TX)
Physician Assistant Taxonomy 363A00000X · Licence TEMPORARY (TX)

Record details

NPI number1104301852
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 28, 2018
Last updated in NPPESJune 29, 2022
Certification dateJune 29, 2022
Mailing address2925 Briarpark Dr Ste 575, Houston, TX 77042-3776

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Nluc Pllc — 222 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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