Provider Demographics
NPI:1225778665
Name:AVALOS, JOMARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JOMARIE
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOMARIE
Other - Middle Name:
Other - Last Name:AVALOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:11012 AIRLINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 RETAMA
Practice Address - Street 2:
Practice Address - City:RIO HONDO
Practice Address - State:TX
Practice Address - Zip Code:78583
Practice Address - Country:US
Practice Address - Phone:956-295-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5151Medicaid