Healthcare Provider Details

I. General information

NPI: 1285061192
Provider Name (Legal Business Name): JEANNETTE ULLOA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANNETTE ULLOA CRNA

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0745
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2111
  • Fax:
Mailing address:
  • Phone: 800-994-9722
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP127975
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number114182-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11044120
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number680657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: