Provider Demographics
NPI:1114481470
Name:GLUCKSMAN, JAQUI MELODY (RN)
Entity Type:Individual
Prefix:
First Name:JAQUI
Middle Name:MELODY
Last Name:GLUCKSMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11924 FOREST HILL BLVD # 10A-243
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6256
Mailing Address - Country:US
Mailing Address - Phone:561-693-5143
Mailing Address - Fax:561-245-9150
Practice Address - Street 1:306 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3282
Practice Address - Country:US
Practice Address - Phone:561-693-5143
Practice Address - Fax:561-245-9150
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9340635163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse