Provider Demographics
NPI:1851141824
Name:HIGHSMITH, JACQUIN DEBORAH
Entity Type:Individual
Prefix:
First Name:JACQUIN
Middle Name:DEBORAH
Last Name:HIGHSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 RONDO LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1214
Mailing Address - Country:US
Mailing Address - Phone:585-506-6988
Mailing Address - Fax:
Practice Address - Street 1:537 RONDO LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1214
Practice Address - Country:US
Practice Address - Phone:585-506-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342781164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse