Healthcare Provider Details

I. General information

NPI: 1558404137
Provider Name (Legal Business Name): JACQUELINE CECELIA WHITING ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W. DR. M.L. KING BLVD
TAMPA FL
33607
US

IV. Provider business mailing address

756 VALLANCE WAY NE
ST PETERSBURG FL
33716-3436
US

V. Phone/Fax

Practice location:
  • Phone: 813-554-8211
  • Fax:
Mailing address:
  • Phone: 727-576-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberARNP 2185732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: