Provider Demographics
NPI:1740688910
Name:EDWARDS, JACQUELINE CAROLYN (NP, RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CAROLYN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:8081 TARA BLVD
Mailing Address - Street 2:265
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236
Mailing Address - Country:US
Mailing Address - Phone:678-815-5446
Mailing Address - Fax:188-829-1928
Practice Address - Street 1:8081 TARA BLVD
Practice Address - Street 2:265
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:678-815-5446
Practice Address - Fax:188-829-1928
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28131113A163W00000X
GARN139678163W00000X, 363LF0000X
IN71005657A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse