Healthcare Provider Details

I. General information

NPI: 1598073835
Provider Name (Legal Business Name): JENNIFER MARIE BLAKE MS, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SETON PKWY
ROUND ROCK TX
78665-8000
US

IV. Provider business mailing address

201 SETON PKWY
ROUND ROCK TX
78665-8000
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number4704258847
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704258847
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number795600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: