Healthcare Provider Details

I. General information

NPI: 1164713251
Provider Name (Legal Business Name): PATRICIA A JACQUES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10845 N PINTO DR
FOUNTAIN HILLS AZ
85268-5326
US

IV. Provider business mailing address

10845 N PINTO DR
FOUNTAIN HILLS AZ
85268-5326
US

V. Phone/Fax

Practice location:
  • Phone: 978-623-4254
  • Fax: 978-428-2441
Mailing address:
  • Phone: 978-623-4254
  • Fax: 978-428-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN281239
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: