Provider Demographics
NPI:1467216796
Name:ROSS, JACIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACIE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 HONEY BEAR DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-5309
Mailing Address - Country:US
Mailing Address - Phone:409-548-1970
Mailing Address - Fax:409-670-0044
Practice Address - Street 1:610 STRICKLAND DR STE 340
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4788
Practice Address - Country:US
Practice Address - Phone:409-670-0044
Practice Address - Fax:409-750-7107
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily