Provider Demographics
NPI:1700901766
Name:GAMEZ, JENNIFER E (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:E
Last Name:GAMEZ
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 1:113 BLUFF VW
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4536
Mailing Address - Country:US
Mailing Address - Phone:817-441-9270
Mailing Address - Fax:817-568-0501
Practice Address - Street 1:12001 S. FREEWAY SUITE 205
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76108
Practice Address - Country:US
Practice Address - Phone:817-568-0500
Practice Address - Fax:817-568-0501
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX622203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE32713Medicare UPIN
TX86N043Medicare ID - Type Unspecified