Provider Demographics
NPI:1598356024
Name:RAYNOR, JENNILYN TUAZON
Entity Type:Individual
Prefix:
First Name:JENNILYN
Middle Name:TUAZON
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNILYN
Other - Middle Name:POLICARPIO
Other - Last Name:TUAZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:3017 COTTERS CIR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3764
Mailing Address - Country:US
Mailing Address - Phone:214-718-5507
Mailing Address - Fax:
Practice Address - Street 1:3017 COTTERS CIR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3764
Practice Address - Country:US
Practice Address - Phone:214-718-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily