Provider Demographics
NPI:1376122044
Name:PAULUCCI, JEREMY DAVID (APRN)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DAVID
Last Name:PAULUCCI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:6045 TOWBOAT ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-4217
Mailing Address - Country:US
Mailing Address - Phone:702-493-7782
Mailing Address - Fax:
Practice Address - Street 1:3968 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3412
Practice Address - Country:US
Practice Address - Phone:702-791-9020
Practice Address - Fax:702-791-9261
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV837989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily