Provider Demographics
NPI:1184408411
Name:EDGECOMBE, JENNIFER ANN (APRN FNP-BC, FNP-C,)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:EDGECOMBE
Suffix:
Gender:F
Credentials:APRN FNP-BC, FNP-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 SUNSET CLF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2681
Mailing Address - Country:US
Mailing Address - Phone:210-381-5411
Mailing Address - Fax:210-381-5411
Practice Address - Street 1:3611 SUNSET CLF
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-2681
Practice Address - Country:US
Practice Address - Phone:210-381-5411
Practice Address - Fax:210-381-5411
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily