Provider Demographics
NPI:1750854238
Name:LARA, JOCELYN (CNP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAS BORREGAS
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-9599
Mailing Address - Country:US
Mailing Address - Phone:505-414-0635
Mailing Address - Fax:
Practice Address - Street 1:258 EL CERRO LOOP
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9505
Practice Address - Country:US
Practice Address - Phone:505-414-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner