Provider Demographics
NPI:1811410715
Name:PINLAC, JACQUELINE M (MSN, APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:PINLAC
Suffix:
Gender:F
Credentials:MSN, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2906 E UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3430
Mailing Address - Country:US
Mailing Address - Phone:602-699-4536
Mailing Address - Fax:803-265-0563
Practice Address - Street 1:2906 E UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3430
Practice Address - Country:US
Practice Address - Phone:602-699-4536
Practice Address - Fax:803-265-0563
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP10440363LF0000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine