Provider Demographics
NPI:1578921698
Name:IWUJI, JACINTA (NP)
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:
Last Name:IWUJI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1051
Mailing Address - Country:US
Mailing Address - Phone:870-739-9300
Mailing Address - Fax:
Practice Address - Street 1:200 E MILITARY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1811
Practice Address - Country:US
Practice Address - Phone:870-739-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004904363L00000X
TNRN0000213143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily