Provider Demographics
NPI:1417433285
Name:JAUREGUI, JEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:JAUREGUI
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 1:39 STEPNEY LN UNIT 1781
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-8572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 SHOREWAY DR
Practice Address - Street 2:
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658-1680
Practice Address - Country:US
Practice Address - Phone:410-827-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily