Provider Demographics
NPI:1275888455
Name:TALIAFERRO, JACQUISE (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUISE
Middle Name:
Last Name:TALIAFERRO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4040
Mailing Address - Country:US
Mailing Address - Phone:512-271-7017
Mailing Address - Fax:251-220-5536
Practice Address - Street 1:3065 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4040
Practice Address - Country:US
Practice Address - Phone:251-712-7017
Practice Address - Fax:251-220-5536
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111430363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health