Provider Demographics
NPI:1922690965
Name:MCGUIRE, JENNIFER (CAA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4515 MARSHA SHARP FWY
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2520
Mailing Address - Country:US
Mailing Address - Phone:254-396-9910
Mailing Address - Fax:
Practice Address - Street 1:7509 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-8202
Practice Address - Country:US
Practice Address - Phone:806-744-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367H00000X
TX32697880367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant