Healthcare Provider Details

I. General information

NPI: 1649478975
Provider Name (Legal Business Name): JENNIFER LYNN ANDERSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 N 15TH ST
ABILENE TX
79603-4430
US

IV. Provider business mailing address

6023 77TH ST
LUBBOCK TX
79424-1732
US

V. Phone/Fax

Practice location:
  • Phone: 325-673-8892
  • Fax:
Mailing address:
  • Phone: 405-819-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number207966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: