Provider Demographics
NPI:1740046044
Name:QUILAO, JACQUELYN CRUZ (BSN, RN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:CRUZ
Last Name:QUILAO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:REYNALDO
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:9663 BIGGS RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3789
Mailing Address - Country:US
Mailing Address - Phone:443-570-0807
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR171575163WC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine