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General NPI Number Information
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NPI Number | 1821573312
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Entity Type | Individual
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Provider Name | JESSICA PANTOJA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 101 S PRAIRIE ST STE D
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City | DAYTON
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State | TX
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Zip | 77535-0067
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Country | US
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Telephone | 936-340-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 KORINA WAY
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City | CONROE
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State | TX
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Zip | 77306-5021
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 953347
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1182612
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License Number State | TX
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