MEDICARE: JENNIFER MARIE SHADROCK FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	685159	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841212073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE SHADROCK FNP

Provider Business Mailing Address
First Line	:	7555 NW LOOP 410
Second Line	:	SUITE 114
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2148
Country	:	US
Telephone Number	:	210-520-8070
Fax Number	:	210-521-7688

Provider Business Practice Location Address
First Line	:	7555 NW LOOP 410
Second Line	:	SUITE 114
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2148
Country	:	US
Telephone Number	:	210-520-8070
Fax Number	:	210-521-7688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/31/2013

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