Provider Demographics
NPI:1679133870
Name:GOMEZ CHAVE, JESSICA ANDREA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANDREA
Last Name:GOMEZ CHAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ASH DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-6406
Mailing Address - Country:US
Mailing Address - Phone:903-337-6844
Mailing Address - Fax:
Practice Address - Street 1:130 ASH DR
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-6406
Practice Address - Country:US
Practice Address - Phone:903-337-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345494164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse