Provider Demographics
NPI:1508847344
Name:GARCIA, JODIE LYNNE (CFNP)
Entity Type:Individual
Prefix:MS
First Name:JODIE
Middle Name:LYNNE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 12TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4066
Mailing Address - Country:US
Mailing Address - Phone:505-259-2767
Mailing Address - Fax:
Practice Address - Street 1:1790 GRANDE BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1756
Practice Address - Country:US
Practice Address - Phone:505-272-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR31062363LF0000X
NMCNP00633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily