Provider Demographics
NPI:1649726191
Name:RASOOLI, JACQUELINE ANN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANN
Last Name:RASOOLI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5964 W PARKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7788
Mailing Address - Country:US
Mailing Address - Phone:469-495-9122
Mailing Address - Fax:
Practice Address - Street 1:5964 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7788
Practice Address - Country:US
Practice Address - Phone:469-495-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily