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General NPI Number Information
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NPI Number | 1043971914
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Entity Type | Individual
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Provider Name | JENNA GRACE TANCREDI
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 1935 MEDICAL DISTRICT DR
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 954-262-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 STATE ST APT 846
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City | DALLAS
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State | TX
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Zip | 75204-2773
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Country | US
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Telephone | 610-609-9549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17348
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | PA17348
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License Number State | TX
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