Healthcare Provider Details

I. General information

NPI: 1164922811
Provider Name (Legal Business Name): JACQUELINE OOTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 7TH ST S
ST PETERSBURG FL
33701-4708
US

IV. Provider business mailing address

601 7TH ST S
ST PETERSBURG FL
33701-4708
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-6234
  • Fax: 727-553-7422
Mailing address:
  • Phone: 727-893-6234
  • Fax: 727-553-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9319063
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11002579
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11002579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: