Provider Demographics
NPI:1629649793
Name:AUGUSTO, JACQUELYN (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:AUGUSTO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ASH RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-7514
Mailing Address - Country:US
Mailing Address - Phone:845-863-9633
Mailing Address - Fax:
Practice Address - Street 1:22 ASH RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-7514
Practice Address - Country:US
Practice Address - Phone:845-863-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY711727-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse