Provider Demographics
NPI:1770067167
Name:GUINN, JACQUELINE S (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:S
Last Name:GUINN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6609 KALGAN RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-3519
Mailing Address - Country:US
Mailing Address - Phone:505-225-4654
Mailing Address - Fax:505-225-4654
Practice Address - Street 1:6701 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4318
Practice Address - Country:US
Practice Address - Phone:505-727-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54056207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine