Healthcare Provider Details

I. General information

NPI: 1285546176
Provider Name (Legal Business Name): JITSY SIBI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JITSY JOSE

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 S GENERAL BRUCE DR
TEMPLE TX
76502-1469
US

IV. Provider business mailing address

3311 PELICAN LAKE AVE
EDINBURG TX
78539-1825
US

V. Phone/Fax

Practice location:
  • Phone: 800-423-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1247351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: