MEDICARE: JACKIE ARMIJO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	001806	NV
2	363L00000X	Nurse Practitioner	001806	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851465934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE ARMIJO FNP

Provider Business Mailing Address
First Line	:	2345 E PRATER WAY STE 207
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-9634
Country	:	US
Telephone Number	:	702-492-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 N GIBSON RD STE 201
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-1708
Country	:	US
Telephone Number	:	702-492-1162
Fax Number	:	702-492-1319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	02/28/2020

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