Provider Demographics
NPI:1043826241
Name:ALLEN, JIMMEQUIA LANICE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JIMMEQUIA
Middle Name:LANICE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-0992
Mailing Address - Country:US
Mailing Address - Phone:912-674-9370
Mailing Address - Fax:
Practice Address - Street 1:117 JAMES ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-3568
Practice Address - Country:US
Practice Address - Phone:912-576-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271383163WH1000X, 163WM0705X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical