Provider Demographics
NPI:1881191401
Name:CAIN, JACE WILLIAM
Entity Type:Individual
Prefix:
First Name:JACE
Middle Name:WILLIAM
Last Name:CAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 RODD FIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5027
Mailing Address - Country:US
Mailing Address - Phone:361-900-7270
Mailing Address - Fax:
Practice Address - Street 1:1702 RODD FIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-5027
Practice Address - Country:US
Practice Address - Phone:361-900-5782
Practice Address - Fax:361-371-7270
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137708363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner