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General NPI Number Information
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NPI Number | 1578288189
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Entity Type | Individual
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Provider Name | JACLYN RENE GUTIERREZ
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Gender | Female
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 720 W 34TH ST # 104
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City | AUSTIN
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State | TX
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Zip | 78705-1205
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Country | US
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Telephone | 512-261-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 S MOPAC EXPY APT 837
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City | AUSTIN
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State | TX
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Zip | 78746-7965
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Country | US
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Telephone | 832-865-7489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1095990
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License Number State | TX
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