Provider Demographics
NPI:1487939849
Name:APODACA, JENNIFER JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JEAN
Last Name:APODACA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:20403 LIATRIS LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2251
Mailing Address - Country:US
Mailing Address - Phone:210-857-0427
Mailing Address - Fax:
Practice Address - Street 1:3100 SCHOFIELD RD
Practice Address - Street 2:BUILDING 1179
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7577
Practice Address - Country:US
Practice Address - Phone:210-808-2457
Practice Address - Fax:210-808-3515
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical