Individual
JENNY IDICULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3705 MEDICAL PKWY STE 570, AUSTIN, TX 78705-1024
(512) 454-2554
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
860986
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
1052820
TX
367500000X
Certified Registered Nurse Anesthetist
RNA253034
ME
Other
Enumeration date
03/28/2021
Last updated
02/26/2026
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