Provider Demographics
NPI:1942844121
Name:JOSE, RENY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RENY
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 FRISCO SQUARE BLVD APT 2025
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0160
Mailing Address - Country:US
Mailing Address - Phone:718-614-1029
Mailing Address - Fax:
Practice Address - Street 1:2591 FM 423
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6664
Practice Address - Country:US
Practice Address - Phone:972-731-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032426363LF0000X
NYF341913-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily