Provider Demographics
NPI:1255317269
Name:MCGUINNESS, JACQUELYNN SUSAN (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:SUSAN
Last Name:MCGUINNESS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:SUSAN
Other - Last Name:MCGUINNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2927
Mailing Address - Country:US
Mailing Address - Phone:704-403-3000
Mailing Address - Fax:704-783-1782
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-3000
Practice Address - Fax:704-783-1782
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2780762363LN0000X
NC187258363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303516600Medicaid