Provider Demographics
NPI:1538368535
Name:BLOCK, JANELLE M (NP)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:M
Last Name:BLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8217 SHOAL CREEK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7664
Mailing Address - Country:US
Mailing Address - Phone:512-485-7208
Mailing Address - Fax:844-964-8678
Practice Address - Street 1:411 S KING ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-609-9478
Practice Address - Fax:830-433-9089
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP122375363L00000X
WI3076-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP122375OtherTEXAS MEDICAL LICENSE
TXPO1477395OtherRR MEDICARE
TX319126406Medicaid
TX818270OtherTEXAS MEDICAL LICENSE
TXPO2394873OtherRR MEDICARE