Provider Demographics
NPI:1861183386
Name:AMEZQUITA, JENNIFER MICHAL (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHAL
Last Name:AMEZQUITA
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
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 130
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST STE 113
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2921
Practice Address - Country:US
Practice Address - Phone:915-345-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141317363LP0808X
TX958463163WP0808X
NM76270363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2023103244.OtherANCC BOARD CERTIFICATION
TX1141317OtherPMHNP-BC TX LICENSE
NM76270OtherPMHNP-BC NM LICENSE