1922285279 NPI number — AMANDA DIANE JOJOLA FNP

Table of content: AMANDA DIANE JOJOLA FNP (NPI 1922285279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922285279 NPI number — AMANDA DIANE JOJOLA FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOJOLA
Provider First Name:
AMANDA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUINTANA
Provider Other First Name:
AMANDA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922285279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOSA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81101-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-589-5161
Provider Business Mailing Address Fax Number:
719-589-5722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 BLANCA AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOSA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81101-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-589-3658
Provider Business Practice Location Address Fax Number:
719-589-9514
Provider Enumeration Date:
01/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  93845 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)