Healthcare Provider Details

I. General information

NPI: 1508847344
Provider Name (Legal Business Name): JODIE LYNNE GARCIA CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 GRANDE BLVD SE
RIO RANCHO NM
87124-1756
US

IV. Provider business mailing address

1835 12TH AVE SE
RIO RANCHO NM
87124-4066
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8735
  • Fax:
Mailing address:
  • Phone: 505-259-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR31062
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00633
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: