MEDICARE: AMANDA JACQUES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	082661-21	NH

General Provider Information

NPI Number	:	1417772369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JACQUES

Provider Business Mailing Address
First Line	:	330 BORTHWICK AVE STE 101
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4102
Country	:	US
Telephone Number	:	603-436-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 BORTHWICK AVE STE 101
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4102
Country	:	US
Telephone Number	:	603-436-7171
Fax Number	:	603-433-5931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2024
Last Update Date	:	07/17/2025

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Directions to “ AMANDA JACQUES ” Practice Location

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