Provider Demographics
NPI:1215115860
Name:EUSANIO, JENNIFER RENEE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:EUSANIO
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 1:408 FAIRWAY BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5094
Mailing Address - Country:US
Mailing Address - Phone:214-794-9432
Mailing Address - Fax:
Practice Address - Street 1:8335 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5716
Practice Address - Country:US
Practice Address - Phone:214-706-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L1295Medicare UPIN