Healthcare Provider Details
I. General information
NPI: 1407737414
Provider Name (Legal Business Name): JONATHAN CALEB TOVAR BSN-RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
512 LA ENTRADA CIR
SUNLAND PARK NM
88063-9633
US
IV. Provider business mailing address
512 LA ENTRADA CIR
SUNLAND PARK NM
88063-9633
US
V. Phone/Fax
- Phone: 915-478-2440
- Fax:
- Phone: 915-478-2440
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0200X |
| Taxonomy | Critical Care Medicine Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0807X |
| Taxonomy | Child & Adolescent Psychiatric/Mental Health Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
| # 11 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 82034 |
| License Number State | NM |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
