MEDICARE: JACARRA HUDSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1100644	TX

General Provider Information

NPI Number	:	1104671718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACARRA HUDSON FNP-BC

Provider Business Mailing Address
First Line	:	9802 FM 1960 BYPASS RD W STE 205
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-3510
Country	:	US
Telephone Number	:	281-570-2961
Fax Number	:

Provider Business Practice Location Address
First Line	:	9802 FM 1960 BYPASS RD W STE 205
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-3510
Country	:	US
Telephone Number	:	281-570-2961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	04/18/2024

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