Provider Demographics
NPI:1831469477
Name:JACQUES, EVA MIREILLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:MIREILLE
Last Name:JACQUES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1084
Mailing Address - Country:US
Mailing Address - Phone:954-673-4065
Mailing Address - Fax:
Practice Address - Street 1:388 SW 163RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1084
Practice Address - Country:US
Practice Address - Phone:954-673-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3082172363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health