Provider Demographics
NPI:1790075422
Name:MAKARENKO, JADE MICHELE (CPNP)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:MICHELE
Last Name:MAKARENKO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:
Other - Last Name:GROOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:220 ATHENS WAY STE 240
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1311
Mailing Address - Country:US
Mailing Address - Phone:832-828-3600
Mailing Address - Fax:
Practice Address - Street 1:3200 SOUTHWEST FWY STE 2100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7525
Practice Address - Country:US
Practice Address - Phone:833-208-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX739918163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics