Provider Demographics
NPI:1659925337
Name:SMITH, JACQUELINE GAJEWSKI (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:GAJEWSKI
Last Name:SMITH
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 1:130 SE CRESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7438
Mailing Address - Country:US
Mailing Address - Phone:561-758-3524
Mailing Address - Fax:
Practice Address - Street 1:130 SE CRESTWOOD CIR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7438
Practice Address - Country:US
Practice Address - Phone:561-758-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002728363LG0600X
FL11002728363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology