Provider Demographics
NPI:1083962302
Name:HASSAD, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HASSAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 ROCK SPRINGS RD
Mailing Address - Street 2:SUITE 259
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2229
Mailing Address - Country:US
Mailing Address - Phone:954-893-9499
Mailing Address - Fax:954-893-9455
Practice Address - Street 1:1631 ROCK SPRINGS RD
Practice Address - Street 2:SUITE 259
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2229
Practice Address - Country:US
Practice Address - Phone:954-893-9499
Practice Address - Fax:954-893-9455
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 172313374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide