Provider Demographics
NPI:1083802441
Name:JOSE, MARILYN (FNP, ACNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:FNP, ACNP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:POY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:FONDREN 270
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-0006
Mailing Address - Fax:713-790-2727
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:823-355-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613487363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01045652OtherRR MEDICARE
TX1790997526OtherBLUE CROSS BLUE SHIELD
TX219966302Medicaid
TX219966301Medicaid
TX219966302Medicaid
TX219966301Medicaid