Individual
JACQUELYN LARUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1650 W COLLEGE ST, GRAPEVINE, TX 76051
(817) 481-1588
Mailing address
1601 WHITE WILLOW LN, ARLINGTON, TX 76002-4645
(985) 790-2260
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
S0492
TX
Other
Enumeration date
04/03/2016
Last updated
08/08/2019
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