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NPI Code Detail

MEDICARE: MRS. JAQUETA ANTANINA WILLIAMS FNP

MEDICARE: MRS. JAQUETA ANTANINA WILLIAMS FNP
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
1363LF0000XFamily Nurse Practitioner2017014619MO
2363LF0000XFamily Nurse Practitioner872356NV
3363LP0808XPsychiatric/Mental Health Nurse PractitionerF405824NY
4363LF0000XFamily Nurse Practitioner95006450CA
5363LP0808XPsychiatric/Mental Health Nurse PractitionerTELE310454AZ

General Provider Information

NPI Number : 1952830168
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAQUETA ANTANINA WILLIAMS FNP
Provider Business Mailing Address
First Line : 11141 RYDER RD
Second Line :
City : JURUPA VALLEY
State : CA
Zip : 91752-5098
Country : US
Telephone Number : 314-322-7627
Fax Number :
Provider Business Practice Location Address
First Line : 11428 KENYON WAY
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91701-9234
Country : US
Telephone Number : 951-780-1835
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2017
Last Update Date : 07/12/2024

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