Provider Demographics
NPI:1740366087
Name:JAQUEZ, ROBIN KAY (NP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:KAY
Last Name:JAQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:LOYALTON
Mailing Address - State:CA
Mailing Address - Zip Code:96118-0007
Mailing Address - Country:US
Mailing Address - Phone:530-993-6704
Mailing Address - Fax:530-993-6790
Practice Address - Street 1:202 FRONT ST.
Practice Address - Street 2:
Practice Address - City:LOYALTON
Practice Address - State:CA
Practice Address - Zip Code:96118-0007
Practice Address - Country:US
Practice Address - Phone:530-993-6704
Practice Address - Fax:530-993-6790
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily