Provider Demographics
NPI:1114375227
Name:GLICK, JESSICA NU (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NU
Last Name:GLICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9305 PINECROFT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3482
Mailing Address - Country:US
Mailing Address - Phone:713-897-7005
Mailing Address - Fax:713-897-7006
Practice Address - Street 1:9305 PINECROFT DR STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3482
Practice Address - Country:US
Practice Address - Phone:713-897-7005
Practice Address - Fax:713-897-7006
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10057687390200000X
TXR4228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program