Provider Demographics
NPI:1558732057
Name:SALAZAR, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 HARVEST KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1643
Mailing Address - Country:US
Mailing Address - Phone:281-635-1759
Mailing Address - Fax:
Practice Address - Street 1:2023 N MASON RD STE 204
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3779
Practice Address - Country:US
Practice Address - Phone:281-394-0370
Practice Address - Fax:281-206-7474
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX564720ZHGEMedicare PIN