Provider Demographics
NPI:1255687042
Name:VARISTE, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VARISTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1651 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8652
Practice Address - Country:US
Practice Address - Phone:979-693-7400
Practice Address - Fax:979-693-7446
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8822208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-1861OtherMEDICARE FACILITY NUMBER
TX1275726853OtherFACILITY NPI
TX1878423-01OtherFACILITY TPI
TX1275726853OtherFACILITY NPI