Provider Demographics
NPI:1053811752
Name:PATE, JIVA MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JIVA
Middle Name:MARIE
Last Name:PATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3329
Mailing Address - Country:US
Mailing Address - Phone:830-426-5288
Mailing Address - Fax:830-426-5290
Practice Address - Street 1:2912 AVENUE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3329
Practice Address - Country:US
Practice Address - Phone:830-426-5288
Practice Address - Fax:830-426-5290
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139482207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine