Provider Demographics
NPI:1235535469
Name:NEAL, JACQUELINE MARIE (CNA)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:NEAL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 GENTER DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5864
Mailing Address - Country:US
Mailing Address - Phone:352-942-0947
Mailing Address - Fax:
Practice Address - Street 1:12339 GENTER DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5864
Practice Address - Country:US
Practice Address - Phone:352-942-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL303251376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide