Provider Demographics
NPI:1760712616
Name:FERNANDES, JACQUELINE DUPUIS (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DUPUIS
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2401
Mailing Address - Country:US
Mailing Address - Phone:401-274-1100
Mailing Address - Fax:
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-274-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37535363L00000X
RIAPRN00546363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics