Provider Demographics
NPI:1679173652
Name:SOLIS, JENNIFER ANDREA (NP-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANDREA
Last Name:SOLIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 MONTERREY OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2593
Mailing Address - Country:US
Mailing Address - Phone:210-947-6040
Mailing Address - Fax:
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 100
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3204
Practice Address - Country:US
Practice Address - Phone:210-654-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003569207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine