Provider Demographics
NPI:1780279133
Name:HAFNER, JACQUELINE MICHELE (ACNPC-AG)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MICHELE
Last Name:HAFNER
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5259 SUMMER WIND LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9598
Mailing Address - Country:US
Mailing Address - Phone:901-297-0637
Mailing Address - Fax:
Practice Address - Street 1:5259 SUMMER WIND LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9598
Practice Address - Country:US
Practice Address - Phone:901-297-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner