Provider Demographics
NPI:1659516615
Name:GREEN-CALDERON, JARRA L (APRN, FNP-C, BC-ADM)
Entity Type:Individual
Prefix:MRS
First Name:JARRA
Middle Name:L
Last Name:GREEN-CALDERON
Suffix:
Gender:F
Credentials:APRN, FNP-C, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8428 BANDERA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2514
Mailing Address - Country:US
Mailing Address - Phone:210-701-8890
Mailing Address - Fax:
Practice Address - Street 1:8428 BANDERA RD STE 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2514
Practice Address - Country:US
Practice Address - Phone:210-701-8890
Practice Address - Fax:210-783-8840
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143451363LF0000X, 207RE0101X
TX754909133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133N00000XDietary & Nutritional Service ProvidersNutritionist