Healthcare Provider Details

I. General information

NPI: 1548006190
Provider Name (Legal Business Name): JENNIFER RAE OLMOS DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 03/10/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 S STAPLES ST STE 300
CORPUS CHRISTI TX
78404-3113
US

IV. Provider business mailing address

7758 LARIAT TOSS DR
CORPUS CHRISTI TX
78414-1428
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-1498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1168159
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: