Provider Demographics
NPI:1164206447
Name:KNAUSS, JAQULIN (NP)
Entity Type:Individual
Prefix:
First Name:JAQULIN
Middle Name:
Last Name:KNAUSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 ROTHBURY WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6508
Mailing Address - Country:US
Mailing Address - Phone:910-524-0518
Mailing Address - Fax:
Practice Address - Street 1:1135 MILITARY CUTOFF RD STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3685
Practice Address - Country:US
Practice Address - Phone:910-509-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily