Provider Demographics
NPI:1295429801
Name:STOWERS, JACQUELINE G
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:G
Last Name:STOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 EDGEWOOD AVE W UNIT 9351
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-9208
Mailing Address - Country:US
Mailing Address - Phone:904-994-8124
Mailing Address - Fax:
Practice Address - Street 1:9921 NORTH KINGS RD
Practice Address - Street 2:UNIT #107
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219
Practice Address - Country:US
Practice Address - Phone:904-994-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2055X, 3747P1801X, 374U00000X, 376J00000X, 385H00000X, 385HR2060X, 385HR2065X
FL239373376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child