Provider Demographics
NPI:1730107111
Name:FREIRE, JACQUELINE (ARNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FREIRE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 SW 29TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3225
Mailing Address - Country:US
Mailing Address - Phone:305-325-8588
Mailing Address - Fax:954-943-2666
Practice Address - Street 1:2387 W 68TH ST STE 401
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6890
Practice Address - Country:US
Practice Address - Phone:305-325-8588
Practice Address - Fax:954-943-2666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9171380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8437ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER