Healthcare Provider Details

I. General information

NPI: 1013217876
Provider Name (Legal Business Name): LAFITTE JERMAINE HOLMES SR. CLINICAL NURSE SPEC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 E SOUTHCROSS BLVD STE # 145
SAN ANTONIO TX
78222-3735
US

IV. Provider business mailing address

4212 E SOUTHCROSS BLVD STE # 145
SAN ANTONIO TX
78222-3735
US

V. Phone/Fax

Practice location:
  • Phone: 210-447-3033
  • Fax: 210-447-3036
Mailing address:
  • Phone: 210-447-3033
  • Fax: 210-447-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number667360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: