1265921928 NPI number — DR. JACQUELINE EUNICE HAYWOOD PHD

Table of content: DR. JACQUELINE EUNICE HAYWOOD PHD (NPI 1265921928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265921928 NPI number — DR. JACQUELINE EUNICE HAYWOOD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYWOOD
Provider First Name:
JACQUELINE
Provider Middle Name:
EUNICE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265921928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 KNIGHT BOXX RD APT 8301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32065-8049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 KNIGHT BOXX RD APT 8301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32065-8049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-247-4381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2018

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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