Provider Demographics
NPI:1497723928
Name:WALSCH, JACQUELINE LEE (PHD, ARNP)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEE
Last Name:WALSCH
Suffix:
Gender:F
Credentials:PHD, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10032 OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2004
Mailing Address - Country:US
Mailing Address - Phone:727-392-3041
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1199632363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health