Healthcare Provider Details

I. General information

NPI: 1407444920
Provider Name (Legal Business Name): JENNIFER MADALENE JUAREZ RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19026 STONE OAK PKWY STE 210B
SAN ANTONIO TX
78258-3229
US

IV. Provider business mailing address

3806 MIRA MESA
SAN ANTONIO TX
78259-2438
US

V. Phone/Fax

Practice location:
  • Phone: 210-491-1348
  • Fax:
Mailing address:
  • Phone: 210-749-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number913415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: