Individual ProviderJennifer Lisa GustafsonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1600 W 38th St, Suite 300, Austin, TX 78731-6400(512) 261-4800(512) 422-1991PECOS EnrollmentBased on the most recent information from CMS, provider Jennifer Lisa Gustafson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:13 AM.Profile DetailsProvider ID1396154985Provider TypeIndividualFull NameGustafson, Jennifer LisaCredentialFNPGenderFemaleSole ProprietorNoEnumeration Date8/7/2014Last Updated11/28/2014Contact InformationPractice LocationPractice Address1600 W 38th St, Suite 300, Austin, TX 78731-6400Phone(512) 261-4800FaxUnlisted FaxMailing LocationMailing Address14705 Little Fox Trl, Austin, TX 78734-2368Phone(512) 422-1991FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP125891Texas