Provider Demographics
NPI:1114161254
Name:CHASE, JACQUELINE ANN
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:ANN
Last Name:CHASE
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 1:1419 ROYAL SAINT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8030
Mailing Address - Country:US
Mailing Address - Phone:407-736-1842
Mailing Address - Fax:
Practice Address - Street 1:1419 ROYAL SAINT GEORGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8030
Practice Address - Country:US
Practice Address - Phone:407-736-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 148312372600000X
FL186785372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion