Provider Demographics
NPI:1780484931
Name:PAWELSKI, JACQULYN TAYLOR (APRN, AGACNP-BP)
Entity type:Individual
Prefix:
First Name:JACQULYN
Middle Name:TAYLOR
Last Name:PAWELSKI
Suffix:
Gender:F
Credentials:APRN, AGACNP-BP
Other - Prefix:MRS
Other - First Name:JACQULYN
Other - Middle Name:TAYLOR
Other - Last Name:PAWELSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, AGACNP-BP
Mailing Address - Street 1:5605 N MACARTHUR BLVD STE 740
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2626
Mailing Address - Country:US
Mailing Address - Phone:214-960-5681
Mailing Address - Fax:214-960-5681
Practice Address - Street 1:3500 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3460
Practice Address - Country:US
Practice Address - Phone:254-485-7915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX880769163W00000X
TX1193148363L00000X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology