Provider Demographics
NPI:1639418239
Name:BALARBAR, JACQUELINE ABALOS (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ABALOS
Last Name:BALARBAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:A
Other - Last Name:BALARBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, APRN
Mailing Address - Street 1:315 N SHILOH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5783
Mailing Address - Country:US
Mailing Address - Phone:972-205-0440
Mailing Address - Fax:469-458-9121
Practice Address - Street 1:315 N SHILOH RD STE 102
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5783
Practice Address - Country:US
Practice Address - Phone:972-205-0440
Practice Address - Fax:469-458-9121
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX777072363LF0000X
TXAP123129363LF0000X
TXF1012339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF1012339OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS