Healthcare Provider Details

I. General information

NPI: 1922427996
Provider Name (Legal Business Name): JASON GROSECLOSE APRN,FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N PATRICK ST
DUBLIN TX
76446-1918
US

IV. Provider business mailing address

305 N PATRICK ST
DUBLIN TX
76446-1918
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-4900
  • Fax: 254-445-4693
Mailing address:
  • Phone: 254-445-4900
  • Fax: 254-445-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125309
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: