Provider Demographics
NPI:1164538427
Name:SLOVACEK, JAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:
Last Name:SLOVACEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FM 1764 RD STE 190
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-2826
Mailing Address - Country:US
Mailing Address - Phone:281-886-8964
Mailing Address - Fax:
Practice Address - Street 1:3128 S HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4737
Practice Address - Country:US
Practice Address - Phone:281-886-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188121105Medicaid
TX1164538427OtherTRICARE SOUTH
TX188121102Medicaid
TX188121103Medicaid
TX8Y9999OtherBCBSTX
TX188121104Medicaid
TX8L13738Medicare PIN
TXP00760882Medicare PIN
TX1164538427OtherTRICARE SOUTH
TX8Y9999OtherBCBSTX
TX188121104Medicaid
TX8L19993Medicare PIN