Provider Demographics
NPI:1780457036
Name:SHOWALTER, JACQUELINE OLA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:OLA
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 EVENING SHADE DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7461
Mailing Address - Country:US
Mailing Address - Phone:843-224-8178
Mailing Address - Fax:
Practice Address - Street 1:905 DUKES ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2059
Practice Address - Country:US
Practice Address - Phone:843-563-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily