Provider Demographics
NPI:1952344897
Name:COBB, JENNIFER SUZETTE (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUZETTE
Last Name:COBB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-599-9600
Mailing Address - Fax:972-599-9696
Practice Address - Street 1:8080 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4000
Practice Address - Country:US
Practice Address - Phone:972-596-9511
Practice Address - Fax:972-867-8163
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ26553Medicare UPIN
TX8C6947Medicare ID - Type UnspecifiedMEDICARE NUMBER