Provider Demographics
NPI:1902954407
Name:JACQUET, LISA H (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:H
Last Name:JACQUET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:H
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSA
Mailing Address - Street 1:1 UNF DR BLDG 39A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7699
Mailing Address - Country:US
Mailing Address - Phone:904-620-2900
Mailing Address - Fax:
Practice Address - Street 1:1 UNF DR BLDG 39A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7699
Practice Address - Country:US
Practice Address - Phone:904-620-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN - 1624363LF0000X
WAAP30007844363LF0000X
FLAPRN11016071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily