Healthcare Provider Details

I. General information

NPI: 1174194062
Provider Name (Legal Business Name): JARROD PAUL HERTZLER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W 45TH ST
AUSTIN TX
78751-3014
US

IV. Provider business mailing address

300 E HIGHLAND MALL BLVD STE 1A
AUSTIN TX
78752-3746
US

V. Phone/Fax

Practice location:
  • Phone: 512-320-1500
  • Fax: 512-459-1399
Mailing address:
  • Phone: 512-320-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029168
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1054584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: