Provider Demographics
NPI:1740784909
Name:VANEGAS, JAIZA DELA CRUZ (FNP)
Entity Type:Individual
Prefix:
First Name:JAIZA
Middle Name:DELA CRUZ
Last Name:VANEGAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JAIZA
Other - Middle Name:DELA CRUZ
Other - Last Name:VISTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:13414 RAVENS PARK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4061
Mailing Address - Country:US
Mailing Address - Phone:832-332-5812
Mailing Address - Fax:
Practice Address - Street 1:13414 RAVENS PARK LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:832-332-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137025363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care