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General NPI Number Information
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NPI Number | 1518625730
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Entity Type | Individual
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Provider Name | JENNIFER MAE NICKEL NP
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Gender | Female
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Dates
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Enumeration Date | 12/05/2021
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 311 SPRING GREEN BLVD
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-582-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 311 SPRING GREEN BLVD
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-582-7700
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 783433
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1069026
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License Number State | TX
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