Provider Demographics
NPI:1790763944
Name:CARDENAS, JACQUELINE TUCKER (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:TUCKER
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 COLLINSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3936
Mailing Address - Country:US
Mailing Address - Phone:919-553-7646
Mailing Address - Fax:919-553-7646
Practice Address - Street 1:7201 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9268
Practice Address - Country:US
Practice Address - Phone:919-266-7600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC201741OtherNC MEDICAL BOARD LICENSE
0375652OtherANCC FNP ID
NC51349OtherRN LICENSE