Healthcare Provider Details

I. General information

NPI: 1972333078
Provider Name (Legal Business Name): JENNIFER LYNN ROESNER APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 N FM 620 RD
AUSTIN TX
78717-1126
US

IV. Provider business mailing address

208 BELLA COLINAS DR
AUSTIN TX
78738-7631
US

V. Phone/Fax

Practice location:
  • Phone: 737-236-6400
  • Fax:
Mailing address:
  • Phone: 512-840-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1167240
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: