Provider Demographics
NPI:1720606767
Name:COBOS, JONNIE
Entity Type:Individual
Prefix:
First Name:JONNIE
Middle Name:
Last Name:COBOS
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 1:217 CREEKVIEW DR APT 102
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3492
Mailing Address - Country:US
Mailing Address - Phone:214-650-6298
Mailing Address - Fax:
Practice Address - Street 1:217 CREEKVIEW DR APT 102
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3492
Practice Address - Country:US
Practice Address - Phone:214-650-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX986599163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse