Provider Demographics
NPI:1740939446
Name:THOMPSON, JACQUELINE JOY
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JOY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:URESSENTIALS SERVICE
Mailing Address - Street 1:640 NW 183RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4470
Mailing Address - Country:US
Mailing Address - Phone:305-733-4759
Mailing Address - Fax:
Practice Address - Street 1:640 NW 183RD ST STE 1
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4470
Practice Address - Country:US
Practice Address - Phone:305-733-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist