Healthcare Provider Details

I. General information

NPI: 1376463018
Provider Name (Legal Business Name): AMANDA GRACE JACO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING # 51 SPC MARLON JACKSON BLVD KENNEDY STREET
HOHENFELS GERMANY
92366
DE

IV. Provider business mailing address

PSC 414 BOX 2537
APO AE
09173-0026
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN-76282
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: