Provider Demographics
NPI:1902187107
Name:MENDOZA-LU, JACQUELINE LIMOS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LIMOS
Last Name:MENDOZA-LU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:LIMOS
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:15291 SW 46TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3637
Mailing Address - Country:US
Mailing Address - Phone:954-914-6927
Mailing Address - Fax:
Practice Address - Street 1:1613 HARRISON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2896
Practice Address - Country:US
Practice Address - Phone:800-437-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily