Healthcare Provider Details

I. General information

NPI: 1871324210
Provider Name (Legal Business Name): JENNIFER LOUISE MUNOZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR STE C
DECATUR TX
76234-3844
US

IV. Provider business mailing address

2264 COUNTY ROAD 4421
RHOME TX
76078-2110
US

V. Phone/Fax

Practice location:
  • Phone: 940-626-2110
  • Fax:
Mailing address:
  • Phone: 682-554-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1170841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: