Provider Demographics
NPI:1750995155
Name:DINGLE, JACQUELINE (BA)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:DINGLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SUGARBUSH CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4434
Mailing Address - Country:US
Mailing Address - Phone:912-996-9261
Mailing Address - Fax:
Practice Address - Street 1:604 SUGARBUSH CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4434
Practice Address - Country:US
Practice Address - Phone:912-996-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home