Healthcare Provider Details

I. General information

NPI: 1578705364
Provider Name (Legal Business Name): JENNIFER TRAINOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 02/26/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 CORRALES RD. SUITE A, BUILDING A
CORRALES NM
87048-9148
US

IV. Provider business mailing address

620 1/2 ALTO ST
SANTA FE NM
87501-2519
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-1514
  • Fax:
Mailing address:
  • Phone: 561-690-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11010336
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP3248
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP01844
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: