Healthcare Provider Details

I. General information

NPI: 1023778016
Provider Name (Legal Business Name): JAYMII NIKOLE LLAMAS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2021
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 ALBERTA AVE
EL PASO TX
79905-2707
US

IV. Provider business mailing address

5130 GATEWAY BLVD E # 51015
EL PASO TX
79905-1608
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5900
  • Fax: 915-215-8615
Mailing address:
  • Phone: 915-215-4480
  • Fax: 915-215-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2021037855
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1054882
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: