Provider Demographics
NPI:1295123818
Name:DE LARA, JESSICA DENISE (PC-PNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DENISE
Last Name:DE LARA
Suffix:
Gender:F
Credentials:PC-PNP-C
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Mailing Address - Street 1:1390 GEORGE DIETER DR STE 100
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7423
Mailing Address - Country:US
Mailing Address - Phone:915-591-7704
Mailing Address - Fax:915-591-7734
Practice Address - Street 1:1390 GEORGE DIETER DR STE 100
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7423
Practice Address - Country:US
Practice Address - Phone:915-591-7704
Practice Address - Fax:915-591-7734
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP127132364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics