Provider Demographics
NPI:1649468273
Name:BRAZIEL, JENNIFER MARIE (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:BRAZIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:STE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4479
Mailing Address - Country:US
Mailing Address - Phone:830-990-4963
Mailing Address - Fax:830-990-1892
Practice Address - Street 1:1020 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4471
Practice Address - Country:US
Practice Address - Phone:830-990-4453
Practice Address - Fax:830-990-7917
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673379363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX833N84OtherBCBS
TX282253801Medicaid
TX833N84OtherBCBS
TX282253801Medicaid