Provider Demographics
NPI:1801220488
Name:DAVIS, JACQUELINE LURECE (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LURECE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 FALLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5920
Mailing Address - Country:US
Mailing Address - Phone:972-896-9501
Mailing Address - Fax:
Practice Address - Street 1:4432 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-4349
Practice Address - Country:US
Practice Address - Phone:214-428-2010
Practice Address - Fax:214-428-2065
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX615946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily