Provider Demographics
NPI:1679016141
Name:LOPEZ MENDOZA, JENNIFER LORRAINE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:LOPEZ MENDOZA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LORRAINE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 WAYMORE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1604
Mailing Address - Country:US
Mailing Address - Phone:915-577-2600
Mailing Address - Fax:
Practice Address - Street 1:300 WAYMORE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1604
Practice Address - Country:US
Practice Address - Phone:915-577-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132238363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care