Provider Demographics
NPI:1083099618
Name:RATLIFF, JENEEN NICOLE (AGPCNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENEEN
Middle Name:NICOLE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:MS
Other - First Name:JENEEN
Other - Middle Name:NICOLE
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7041 BROOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7918
Mailing Address - Country:US
Mailing Address - Phone:601-951-3941
Mailing Address - Fax:972-730-8952
Practice Address - Street 1:7041 BROOKE BLVD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7918
Practice Address - Country:US
Practice Address - Phone:601-951-3941
Practice Address - Fax:972-730-8952
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128337163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse