Provider Demographics
NPI:1497014138
Name:FLOOD, JACQUELINE KELLY (LPN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KELLY
Last Name:FLOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1346
Mailing Address - Country:US
Mailing Address - Phone:718-666-5757
Mailing Address - Fax:
Practice Address - Street 1:46 THRUSH DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1346
Practice Address - Country:US
Practice Address - Phone:718-666-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309901-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse