Provider Demographics
NPI:1740852375
Name:DANIEL, JACQUELYN (CNA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 GREEN VALLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1507
Mailing Address - Country:US
Mailing Address - Phone:334-384-3714
Mailing Address - Fax:
Practice Address - Street 1:919 GREEN VALLEY RD SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1507
Practice Address - Country:US
Practice Address - Phone:334-384-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000038537376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty