Provider Demographics
NPI:1013593029
Name:JACQUEZ, NORMA (RN, APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:
Last Name:JACQUEZ
Suffix:
Gender:F
Credentials:RN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11113 EBB TIDE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2928
Mailing Address - Country:US
Mailing Address - Phone:915-490-8808
Mailing Address - Fax:
Practice Address - Street 1:1671 N ZARAGOZA RD STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-8058
Practice Address - Country:US
Practice Address - Phone:915-996-5210
Practice Address - Fax:915-996-5211
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032878363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care