Healthcare Provider Details

I. General information

NPI: 1922690965
Provider Name (Legal Business Name): JENNIFER MCGUIRE CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER HERRERA

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 MARSHA SHARP FWY
LUBBOCK TX
79407-8202
US

IV. Provider business mailing address

4515 MARSHA SHARP FWY
LUBBOCK TX
79407-2520
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-7223
  • Fax:
Mailing address:
  • Phone: 254-396-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number32697880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: