Healthcare Provider Details

I. General information

NPI: 1982604161
Provider Name (Legal Business Name): JENNIFER A ARNECILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CEDAR BEND DR
AUSTIN TX
78758-5378
US

IV. Provider business mailing address

12221 N. MOPAC EXPRESSWAY
AUSTIN TX
78758-2483
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4026
  • Fax: 512-901-3926
Mailing address:
  • Phone: 512-901-4026
  • Fax: 512-901-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK1972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: