Healthcare Provider Details

I. General information

NPI: 1043634181
Provider Name (Legal Business Name): JENNIFER ROZELLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER TRUGLIO PA-C

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 S 1ST ST
AUSTIN TX
78704-5466
US

IV. Provider business mailing address

2529 S 1ST ST
AUSTIN TX
78704-5466
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9500
  • Fax: 512-978-9558
Mailing address:
  • Phone: 512-978-9500
  • Fax: 512-978-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: