Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ARNP9324388 | FL |
N | 111NI0900X | Internist | ARNP9324388 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN9324388 | FL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9324388 | FL |
NPI | 1073022380 |
---|---|
Provider Name | Julia Jacques |
First Address | Boynton Beach, FL 33435-4921 |
Second Address | Boynton Beach, FL 33435-4921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2017 |
Last Update Date | 23/12/2021 |