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General NPI Number Information
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NPI Number | 1174831648
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Entity Type | Individual
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Provider Name | JENNIFER L LUCIO FNP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2010
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Last Update Date | 09/18/2010
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Provider Practice Location Address
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Address Line | 4920 N EXPRESSWAY ALTON GLOOR PLAZA #101
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City | BROWNSVILLE
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State | TX
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Zip | 78526-4334
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Country | US
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Telephone | 956-350-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 1474 W PRICE RD BOX#536
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8687
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Country | US
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Telephone | 956-350-5530
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 717775
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License Number State | TX
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