Healthcare Provider Details

I. General information

NPI: 1679494462
Provider Name (Legal Business Name): JACQUELINE PADILLA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARPER DR NE STE 401
ALBUQUERQUE NM
87109-3585
US

IV. Provider business mailing address

5700 HARPER DR NE STE 401
ALBUQUERQUE NM
87109-3585
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-9039
  • Fax: 505-715-9039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number58920
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: