Provider Demographics
NPI:1205342623
Name:REVELDEZ, JEANNE BUENAFLOR (FNP)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:BUENAFLOR
Last Name:REVELDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5303 HARRY HINES BLVD FL 6
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-3552
Practice Address - Country:US
Practice Address - Phone:214-645-2020
Practice Address - Fax:214-645-2011
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily