Provider Demographics
NPI:1538240957
Name:JONES, JACQUELYN L (RN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:LAVERN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1290 GOLFVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6738
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:863-519-7696
Practice Address - Street 1:111 N 11TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4325
Practice Address - Country:US
Practice Address - Phone:863-421-3204
Practice Address - Fax:863-421-3210
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9186639163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool