Provider Demographics
NPI:1073120713
Name:BECERRA, JAMI ANTONETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:ANTONETTE
Last Name:BECERRA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:ANTONETTE
Other - Last Name:BECERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 HAWKINS BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6400
Mailing Address - Country:US
Mailing Address - Phone:915-771-8346
Mailing Address - Fax:
Practice Address - Street 1:1111 HAWKINS BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6400
Practice Address - Country:US
Practice Address - Phone:915-771-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60677363LF0000X
TX1004006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily