Provider Demographics
NPI:1518272814
Name:MARIS, JESSICA RENEE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RENEE
Last Name:MARIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SRNA
Mailing Address - Street 1:1617 FANNIN ST
Mailing Address - Street 2:APT 2617
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-7647
Mailing Address - Country:US
Mailing Address - Phone:713-315-1753
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:823-355-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX742454163WC0200X, 390200000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program