Individual
JENNIFER GRACE ZIELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1307 8TH AVE STE 506, FORT WORTH, TX 76104-4142
(817) 332-6092
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
738696
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
312727602
—
TX
01
—
8791UG
BCBS
TX
01
—
P01446813
RR
TX
Enumeration date
12/04/2012
Last updated
12/18/2022
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