Provider Demographics
NPI:1982604161
Name:ARNECILLA, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ARNECILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N. MOPAC EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-901-4026
Mailing Address - Fax:512-901-3926
Practice Address - Street 1:2400 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5378
Practice Address - Country:US
Practice Address - Phone:512-901-4026
Practice Address - Fax:512-901-3926
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80101985Medicaid
TX1871773564OtherORGANIZATION NPI
TX043852502Medicaid
TX8B8052Medicare ID - Type Unspecified
TX551787YNBVMedicare PIN
TXG77889Medicare UPIN