1538240957 NPI number — JACQUELYN L JONES RN

Table of content: JACQUELYN L JONES RN (NPI 1538240957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538240957 NPI number — JACQUELYN L JONES RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JACQUELYN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
LAVERN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538240957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 GOLFVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTOW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33830-6738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-519-7900
Provider Business Mailing Address Fax Number:
863-519-7696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAINES CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33844-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-421-3204
Provider Business Practice Location Address Fax Number:
863-421-3210
Provider Enumeration Date:
10/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WS0200X , with the licence number:  RN9186639 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)