Provider Demographics
NPI:1205659224
Name:CALLARI ROBINSON, JACQUELINE FELICIA (BSN, RN, SANE-A/P,)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FELICIA
Last Name:CALLARI ROBINSON
Suffix:
Gender:F
Credentials:BSN, RN, SANE-A/P,
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:FELICIA
Other - Last Name:CALLARI ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN, SANE- A/P
Mailing Address - Street 1:117 WINYAH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02568
Mailing Address - Country:US
Mailing Address - Phone:508-560-1430
Mailing Address - Fax:
Practice Address - Street 1:117 WINYAH CIRCLE
Practice Address - Street 2:
Practice Address - City:TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02568-0256
Practice Address - Country:US
Practice Address - Phone:508-560-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY414500163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health