Provider Demographics
NPI:1821558883
Name:AQUINO, JEFFREY (BSN, RN, MS, OT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:AQUINO
Suffix:
Gender:M
Credentials:BSN, RN, MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 S FORT APACHE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5565
Mailing Address - Country:US
Mailing Address - Phone:702-948-5095
Mailing Address - Fax:
Practice Address - Street 1:6045 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5565
Practice Address - Country:US
Practice Address - Phone:702-948-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2230225X00000X
NV821347163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist