Healthcare Provider Details

I. General information

NPI: 1497111496
Provider Name (Legal Business Name): JESSICA CAITLYN SERRANO AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7202 N GRAND PKWY W STE 400
SPRING TX
77379-1685
US

IV. Provider business mailing address

7202 N GRAND PKWY W STE 400
SPRING TX
77379-1685
US

V. Phone/Fax

Practice location:
  • Phone: 281-377-5767
  • Fax:
Mailing address:
  • Phone: 322-601-7868
  • Fax: 281-377-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP129908
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: