Provider Demographics
NPI:1518463736
Name:PENA, JASPER ELISABET (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JASPER
Middle Name:ELISABET
Last Name:PENA
Suffix:
Gender:F
Credentials: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 1:1700 N HIGHWAY 77 STE 210
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7832
Mailing Address - Country:US
Mailing Address - Phone:972-937-1210
Mailing Address - Fax:972-937-0243
Practice Address - Street 1:1700 N HIGHWAY 77 STE 210
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-937-1210
Practice Address - Fax:972-937-0243
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily