Provider Demographics
NPI:1437296860
Name:SAMECK, JACQUITA L (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUITA
Middle Name:L
Last Name:SAMECK
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 1:910 ADAMS ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3730
Mailing Address - Country:US
Mailing Address - Phone:256-533-7420
Mailing Address - Fax:256-536-4109
Practice Address - Street 1:910 ADAMS ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3730
Practice Address - Country:US
Practice Address - Phone:256-533-7420
Practice Address - Fax:256-536-4109
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-035752363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51076937OtherBCBS
ALD084OtherMEDICARE
ALG423OtherMEDICARE
ALE709OtherMEDICARE
ALD084OtherMEDICARE