Provider Demographics
NPI:1922427996
Name:GROSECLOSE, JASON (APRN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GROSECLOSE
Suffix:
Gender:M
Credentials:APRN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-1918
Mailing Address - Country:US
Mailing Address - Phone:254-445-4900
Mailing Address - Fax:254-445-4693
Practice Address - Street 1:305 N PATRICK ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-1918
Practice Address - Country:US
Practice Address - Phone:254-445-4900
Practice Address - Fax:254-445-4693
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP125309OtherLICENSE