Provider Demographics
NPI:1720860224
Name:MENDOZA, JERILYN BAUTISTA (APRN)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:BAUTISTA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 N TENAYA WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0495
Mailing Address - Country:US
Mailing Address - Phone:808-330-4566
Mailing Address - Fax:
Practice Address - Street 1:2911 N TENAYA WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0495
Practice Address - Country:US
Practice Address - Phone:808-330-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVRN79205163W00000X
NV871687364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No163W00000XNursing Service ProvidersRegistered Nurse