Provider Demographics
NPI:1558746875
Name:BLUDAU, JEREMY (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BLUDAU
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NEWHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2553
Mailing Address - Country:US
Mailing Address - Phone:361-655-6511
Mailing Address - Fax:
Practice Address - Street 1:2700 CITIZENS PLZ STE 300
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5757
Practice Address - Country:US
Practice Address - Phone:361-573-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily