Healthcare Provider Details

I. General information

NPI: 1417418112
Provider Name (Legal Business Name): TONIA JERRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 W GRAND PKWY S
SUGAR LAND TX
77479-2562
US

IV. Provider business mailing address

17500 W GRAND PKWY S
SUGAR LAND TX
77479-2562
US

V. Phone/Fax

Practice location:
  • Phone: 281-725-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberV9918
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301507119
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: