Provider Demographics
NPI:1740665751
Name:MOTZ, JENNIFER ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MOTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 SURETY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2033
Mailing Address - Country:US
Mailing Address - Phone:915-591-2704
Mailing Address - Fax:915-598-3946
Practice Address - Street 1:6974 GATEWAY BLVD E
Practice Address - Street 2:#F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1118
Practice Address - Country:US
Practice Address - Phone:915-591-2704
Practice Address - Fax:915-598-3946
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09888363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant