Provider Demographics
NPI:1710305792
Name:JACQUES, ERIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 PARKWEST BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4650
Mailing Address - Country:US
Mailing Address - Phone:865-690-3003
Mailing Address - Fax:
Practice Address - Street 1:9330 PARKWEST BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4650
Practice Address - Country:US
Practice Address - Phone:865-690-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily