Provider Demographics
NPI:1548245004
Name:LAKOWSKY-BRUECKNER, JENNIFER L (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LAKOWSKY-BRUECKNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5302
Mailing Address - Country:US
Mailing Address - Phone:713-540-7909
Mailing Address - Fax:
Practice Address - Street 1:5402 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5302
Practice Address - Country:US
Practice Address - Phone:713-540-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9280OtherBLUE CROSS BLUE SHIELD
TX176801202Medicaid
TX176801201Medicaid
TX176801203Medicaid
TX176801202Medicaid
TX176801203Medicaid