Provider Demographics
NPI:1346955358
Name:TIU, JERLY MAY MAYOL (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JERLY MAY
Middle Name:MAYOL
Last Name:TIU
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13118 ROYAL BEND LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-4086
Mailing Address - Country:US
Mailing Address - Phone:713-319-8562
Mailing Address - Fax:
Practice Address - Street 1:13118 ROYAL BEND LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-4086
Practice Address - Country:US
Practice Address - Phone:713-319-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX842600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care