Provider Demographics
NPI:1891126827
Name:LECLERCQ, JACQUELINE (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LECLERCQ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 MERRIMAC COURT
Mailing Address - Street 2:P O BOX 838
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-0892
Mailing Address - Fax:410-535-5677
Practice Address - Street 1:238 MERRIMAC CT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6113
Practice Address - Country:US
Practice Address - Phone:410-535-0892
Practice Address - Fax:410-535-5677
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1119066363LF0000X
MDR119066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily