Provider Demographics
NPI:1841212073
Name:SHADROCK, JENNIFER MARIE (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:SHADROCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 NW LOOP 410
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2148
Mailing Address - Country:US
Mailing Address - Phone:210-520-8070
Mailing Address - Fax:210-521-7688
Practice Address - Street 1:7555 NW LOOP 410
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2148
Practice Address - Country:US
Practice Address - Phone:210-520-8070
Practice Address - Fax:210-521-7688
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS
TXPENDINGMedicaid
TXPENDINGMedicare PIN