Provider Demographics
NPI:1740673029
Name:INCERA, ALEJANDRO JIMENEZ (AGNP)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:JIMENEZ
Last Name:INCERA
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4030 S JONES BLVD
Mailing Address - Street 2:#32169
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89173-8801
Mailing Address - Country:US
Mailing Address - Phone:702-624-5441
Mailing Address - Fax:702-921-0222
Practice Address - Street 1:10885 S EASTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5857
Practice Address - Country:US
Practice Address - Phone:702-419-9977
Practice Address - Fax:702-921-0222
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN001889363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV50532Medicare PIN