Provider Demographics
NPI:1174831648
Name:LUCIO, JENNIFER L (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LUCIO
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 1:1474 W PRICE RD
Mailing Address - Street 2:BOX#536
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8687
Mailing Address - Country:US
Mailing Address - Phone:956-350-5530
Mailing Address - Fax:
Practice Address - Street 1:4920 N EXPRESSWAY
Practice Address - Street 2:ALTON GLOOR PLAZA #101
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4334
Practice Address - Country:US
Practice Address - Phone:956-350-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717775363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics