Provider Demographics
NPI:1689286502
Name:HOJATI, JACQUELINE S (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:HOJATI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 MARY LYNN DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3918
Mailing Address - Country:US
Mailing Address - Phone:515-250-0913
Mailing Address - Fax:
Practice Address - Street 1:475 S 50TH ST STE 600
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6979
Practice Address - Country:US
Practice Address - Phone:515-226-3415
Practice Address - Fax:515-217-4695
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA160441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily