MEDICARE: MRS. JENNIFER ANN EDGECOMBE APRN FNP-BC, FNP-C,

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	1132074	TX

General Provider Information

NPI Number	:	1184408411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN EDGECOMBE APRN FNP-BC, FNP-C,

Provider Business Mailing Address
First Line	:	3611 SUNSET CLF
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2681
Country	:	US
Telephone Number	:	210-381-5411
Fax Number	:	210-381-5411

Provider Business Practice Location Address
First Line	:	3611 SUNSET CLF
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2681
Country	:	US
Telephone Number	:	210-381-5411
Fax Number	:	210-381-5411

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

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/21/2023

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