Provider Demographics
NPI:1922683788
Name:LANDEROS, JENNIFER CAITLIN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CAITLIN
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:CAITLIN
Other - Last Name:CORAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4715 S LAMAR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1307
Mailing Address - Country:US
Mailing Address - Phone:512-442-1996
Mailing Address - Fax:512-441-1093
Practice Address - Street 1:4715 S LAMAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-1307
Practice Address - Country:US
Practice Address - Phone:512-442-1996
Practice Address - Fax:512-441-1093
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily