Provider Demographics
NPI:1326660978
Name:FRAZER, JACQUELINE (ARNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FRAZER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:FILIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2116 SONG SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-8007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3040 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5220
Practice Address - Country:US
Practice Address - Phone:813-331-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9304259163WN0002X
FL646848363LN0000X
FL11010652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal