Provider Demographics
NPI:1700062304
Name:CHECCO DE SOUZA, JOCELYN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:CHECCO DE SOUZA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14856 VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56554-9135
Mailing Address - Country:US
Mailing Address - Phone:763-639-4737
Mailing Address - Fax:
Practice Address - Street 1:810 4TH AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2800
Practice Address - Country:US
Practice Address - Phone:218-236-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700352363LF0000X
MNR201278-2363LF0000X
NDR38151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily