Provider Demographics
NPI:1578274288
Name:JACQUES, JHON WENDY SR
Entity Type:Individual
Prefix:MR
First Name:JHON WENDY
Middle Name:
Last Name:JACQUES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 EMERALD VIS APT C217
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-7238
Mailing Address - Country:US
Mailing Address - Phone:954-795-0387
Mailing Address - Fax:
Practice Address - Street 1:4635 EMERALD VIS APT C217
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-7238
Practice Address - Country:US
Practice Address - Phone:954-795-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)