Basic Information
| Provider Information | |||||||||
| NPI: | 1982604161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARNECILLA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 N. MOPAC EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787582483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014026 | ||||||||
| FaxNumber: | 5129013926 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 CEDAR BEND DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014026 | ||||||||
| FaxNumber: | 5129013926 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 02/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K1972 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 80101985 | 05 | TX | MEDICAID | 1871773564 | 01 | TX | ORGANIZATION NPI | OTHER | 043852502 | 05 | TX | MEDICAID |