Provider Demographics
NPI:1750925475
Name:GARDEN, JACQUELENE DIANE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELENE
Middle Name:DIANE
Last Name:GARDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:JACQUELENE
Other - Middle Name:DIANE
Other - Last Name:SCHIPPERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 CRESTVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577
Mailing Address - Country:US
Mailing Address - Phone:641-673-3000
Mailing Address - Fax:641-673-5846
Practice Address - Street 1:2401 CRESTVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577
Practice Address - Country:US
Practice Address - Phone:641-673-3000
Practice Address - Fax:641-673-5846
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH091549363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health