Provider Demographics
NPI:1538892351
Name:JN JACQUES, MICHELINE
Entity type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:JN JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W COLONIAL DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7156
Mailing Address - Country:US
Mailing Address - Phone:321-347-4378
Mailing Address - Fax:
Practice Address - Street 1:1221 W COLONIAL DR STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7156
Practice Address - Country:US
Practice Address - Phone:321-347-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2522-1965363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical