Provider Demographics
NPI:1750356044
Name:WEAVER, JENNIFER MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 THREE SISTER CIR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4577
Mailing Address - Country:US
Mailing Address - Phone:704-654-7320
Mailing Address - Fax:
Practice Address - Street 1:1305 W PARKWOOD AVE STE 109
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5700
Practice Address - Country:US
Practice Address - Phone:281-648-1025
Practice Address - Fax:281-648-1705
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2764281Medicare PIN
NC0397730004Medicare NSC