Provider Demographics
NPI:1184265050
Name:SAUCEDO, JOSE LUIS (MSN APRN FNP-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:MSN APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5576
Mailing Address - Country:US
Mailing Address - Phone:432-570-0238
Mailing Address - Fax:432-699-3815
Practice Address - Street 1:801 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-8212
Practice Address - Country:US
Practice Address - Phone:432-685-0450
Practice Address - Fax:432-685-0459
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily