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General NPI Number Information
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NPI Number | 1649811316
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Entity Type | Organization
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Legal Business Name | JACEELLI HEALTHCARE
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 213 TIMBERLINE DR
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-5611
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Country | US
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Telephone | 832-215-0223
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Fax |
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Provider Business Mailing Address
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Address Line | 213 TIMBERLINE DR
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-5611
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Country | US
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Telephone | 832-215-0223
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Fax |
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Authorized Official
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Title or Position | OWNER / PRACTITIONER
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Name | JUDE N ABAM
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Credential | NP
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Telephone | 832-215-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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