Provider Demographics
NPI:1699037242
Name:SIFUENTES, JACQUELINE VANESSA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:VANESSA
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:VANESSA
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7420 REMCON CIR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3537
Mailing Address - Country:US
Mailing Address - Phone:915-532-8823
Mailing Address - Fax:915-532-5909
Practice Address - Street 1:7420 REMCON CIR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3537
Practice Address - Country:US
Practice Address - Phone:915-532-8823
Practice Address - Fax:915-532-5909
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily