Provider Demographics
NPI:1679132468
Name:NUNEZ, JUSTINE NICOLE (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:NICOLE
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E LLANO ESTACADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3807
Mailing Address - Country:US
Mailing Address - Phone:575-763-4335
Mailing Address - Fax:575-763-4296
Practice Address - Street 1:921 E LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3807
Practice Address - Country:US
Practice Address - Phone:575-763-4335
Practice Address - Fax:575-763-4296
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily