Healthcare Provider Details

I. General information

NPI: 1639080179
Provider Name (Legal Business Name): JENNIFER GONZALEZ-BAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 WARREN PKWY STE 212
FRISCO TX
75034-4066
US

IV. Provider business mailing address

3628 ESTACADO LN
PLANO TX
75025-4474
US

V. Phone/Fax

Practice location:
  • Phone: 469-476-5623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1244083
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: