Provider Demographics
NPI:1184134611
Name:NIELSEN, JACQUELINE ANNE (APRN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7137 ASHLAND GLN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2405
Mailing Address - Country:US
Mailing Address - Phone:410-440-3174
Mailing Address - Fax:
Practice Address - Street 1:7137 ASHLAND GLN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2405
Practice Address - Country:US
Practice Address - Phone:410-440-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9387936363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health