Provider Demographics
NPI:1255517157
Name:BARTLETT, JACQUELINE JANE (NURSE)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:JANE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W LUCERNE CIR
Mailing Address - Street 2:APT 414
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3728
Mailing Address - Country:US
Mailing Address - Phone:407-864-2770
Mailing Address - Fax:
Practice Address - Street 1:20 WEST LUCERNE CIRCLE
Practice Address - Street 2:APT 414
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801
Practice Address - Country:US
Practice Address - Phone:407-864-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5153837164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse