Provider Demographics
NPI:1114220639
Name:GOULD, JACQUELINE ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:GOULD
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:MESZAROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 428
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3800
Mailing Address - Country:US
Mailing Address - Phone:516-663-2066
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 428
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3800
Practice Address - Country:US
Practice Address - Phone:516-663-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400076203Medicare PIN