MEDICARE: JANICE ANGELINA ENRIQUEZ 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	API39447	TX

General Provider Information

NPI Number	:	1952878530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE ANGELINA ENRIQUEZ FNP

Provider Business Mailing Address
First Line	:	4849 N MESA ST STE 201
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5919
Country	:	US
Telephone Number	:	915-351-6600
Fax Number	:	915-351-6601

Provider Business Practice Location Address
First Line	:	13001 EASTLAKE BLVD STE 105
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-6312
Country	:	US
Telephone Number	:	915-248-2345
Fax Number	:	915-271-4412

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	09/25/2019

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