Provider Demographics
NPI:1790169142
Name:ERBSE, JACQUELINE S (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:ERBSE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-780-5225
Mailing Address - Fax:270-780-0475
Practice Address - Street 1:484 GOLDEN AUTUMN WAY STE 201
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6914
Practice Address - Country:US
Practice Address - Phone:270-780-5225
Practice Address - Fax:270-780-0475
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily