Provider Demographics
NPI:1346216140
Name:MASTER, JACQUELINE JEANNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:JEANNE
Last Name:MASTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2015
Mailing Address - Country:US
Mailing Address - Phone:305-329-3021
Mailing Address - Fax:
Practice Address - Street 1:1550 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2015
Practice Address - Country:US
Practice Address - Phone:305-329-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1679622163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305626100Medicaid
FLU1056YMedicare PIN