Provider Demographics
NPI:1821140781
Name:SCHMIDT, JACQUELINE ELAINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELAINE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:MAD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95552-0101
Mailing Address - Country:US
Mailing Address - Phone:707-574-6170
Mailing Address - Fax:
Practice Address - Street 1:ONE SHIELDS AVENUE DAVINCI COURT
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-754-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily