Provider Demographics
NPI:1376937672
Name:BORELAND, JACQUELINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:BORELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:JACKSON-BORELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:390 RIVERBIRCH LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4558
Mailing Address - Country:US
Mailing Address - Phone:678-376-2565
Mailing Address - Fax:678-376-2307
Practice Address - Street 1:390 RIVERBIRCH LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4558
Practice Address - Country:US
Practice Address - Phone:678-376-2565
Practice Address - Fax:678-376-2307
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN141662163W00000X
CTR49833163W00000X
NY22445006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse