Provider Demographics
NPI:1720381486
Name:KILLEEN, JACQUELINE L (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:L
Last Name:KILLEEN
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:3001 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5155
Mailing Address - Country:US
Mailing Address - Phone:954-456-4888
Mailing Address - Fax:954-456-9721
Practice Address - Street 1:3001 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5155
Practice Address - Country:US
Practice Address - Phone:954-456-4888
Practice Address - Fax:954-456-9721
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 3066702363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology