Provider Demographics
NPI:1780030320
Name:JULARBAL, JED (APRN)
Entity Type:Individual
Prefix:
First Name:JED
Middle Name:
Last Name:JULARBAL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MEDICAL CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2928
Mailing Address - Country:US
Mailing Address - Phone:936-788-1060
Mailing Address - Fax:936-788-2844
Practice Address - Street 1:503 MEDICAL CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2928
Practice Address - Country:US
Practice Address - Phone:936-788-1060
Practice Address - Fax:936-788-2844
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130401363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP130401OtherLICENSE