Provider Demographics
NPI:1952830168
Name:WILLIAMS, JAQUETA ANTANINA (FNP)
Entity type:Individual
Prefix:MRS
First Name:JAQUETA
Middle Name:ANTANINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JAQUETA
Other - Middle Name:ANTANINA
Other - Last Name:ALGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11141 RYDER RD
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-5098
Mailing Address - Country:US
Mailing Address - Phone:314-322-7627
Mailing Address - Fax:
Practice Address - Street 1:11428 KENYON WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9234
Practice Address - Country:US
Practice Address - Phone:951-780-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017014619363LF0000X
NV872356363LF0000X
NYF405824363LP0808X
CA95006450363LF0000X
AZTELE310454363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health