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Contact Information

JACQUELYN LARUSSA, MD
1650 W COLLEGE ST
GRAPEVINE, TX76051
 Phone: 817-481-1588
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for JACQUELYN LARUSSA · (Female)

NPI Number 1093178360
Status Active
Credentials MD
Entity Individual
Enumeration date 04/03/2016
Last updated 08/08/2019 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • TX License # S0492
Hospital affiliation(s)
  • BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE - (Acute Care)
    1650 W COLLEGE ST
    GRAPEVINE, TX 76051
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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