Provider Demographics
NPI:1144826199
Name:NEVAREZ, JACQUELINE CHRISTINE (FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 BLISS AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3106
Mailing Address - Country:US
Mailing Address - Phone:915-309-8082
Mailing Address - Fax:
Practice Address - Street 1:8041 N MESA ST STE B2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1666
Practice Address - Country:US
Practice Address - Phone:915-307-3870
Practice Address - Fax:915-581-2926
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX852800163WE0003X
TX1012264363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily