Provider Demographics
NPI:1568777530
Name:DEL VAL, JACQUELINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:DEL VAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1534
Mailing Address - Country:US
Mailing Address - Phone:754-551-0987
Mailing Address - Fax:
Practice Address - Street 1:4720 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-1534
Practice Address - Country:US
Practice Address - Phone:505-324-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3420682363LA2200X
OR201702559NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health