Provider Demographics
NPI:1508474446
Name:SPEULDA, JENNIFER R (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SPEULDA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 COUNTY ROAD 1225
Mailing Address - Street 2:
Mailing Address - City:LAKE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75450-4824
Mailing Address - Country:US
Mailing Address - Phone:903-366-9010
Mailing Address - Fax:
Practice Address - Street 1:4400 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5586
Practice Address - Country:US
Practice Address - Phone:903-450-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily