Provider Demographics
NPI:1447221668
Name:JOUBERT, JACQUELINE M (RNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 COLLYER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1869
Mailing Address - Country:US
Mailing Address - Phone:401-272-7799
Mailing Address - Fax:401-453-9078
Practice Address - Street 1:195 COLLYER ST STE 201
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1869
Practice Address - Country:US
Practice Address - Phone:401-272-7799
Practice Address - Fax:401-453-9078
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409771OtherBLUE CHIP OF RI
RI1594OtherNEIGHBORHOOD HEALTH PLAN
RI27837-7OtherBLUE CROSS BLUE SHIELD
RI409771OtherBLUE CHIP OF RI
RIQ23736Medicare UPIN