Provider Demographics
NPI:1023376779
Name:CHACON, JACQUELINE YVONNE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:YVONNE
Last Name:CHACON
Suffix:
Gender:F
Credentials:ANP
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Other - First Name:
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Mailing Address - Street 1:91-896 MAKULE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2543
Mailing Address - Country:US
Mailing Address - Phone:808-689-4414
Mailing Address - Fax:808-689-7115
Practice Address - Street 1:91-896 MAKULE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2543
Practice Address - Country:US
Practice Address - Phone:808-689-4414
Practice Address - Fax:808-689-7115
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI1370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily