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General NPI Number Information
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NPI Number | 1215125950
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Entity Type | Organization
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Legal Business Name | JINA VICK, CNP, PC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 303 E WASHINGTON AVE
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City | TUCUMCARI
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State | NM
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Zip | 88401-3873
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Country | US
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Telephone | 505-461-4464
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Fax | 505-461-4474
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Provider Business Mailing Address
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Address Line | 303 E WASHINGTON AVE
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City | TUCUMCARI
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State | NM
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Zip | 88401-3873
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Country | US
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Telephone | 505-461-4464
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Fax | 505-461-4474
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Authorized Official
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Title or Position | PRESIDENT
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Name | JINA R VICK
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Credential | CNP
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Telephone | 505-461-4464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R14987
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License Number State | NM
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