Provider Demographics
NPI:1659840320
Name:COOK, JACQUELINE SIEGRID (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SIEGRID
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 CALICO CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4104
Mailing Address - Country:US
Mailing Address - Phone:979-575-2726
Mailing Address - Fax:
Practice Address - Street 1:2010 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2582
Practice Address - Country:US
Practice Address - Phone:979-821-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138895OtherBOARD OF NURSING