Healthcare Provider Details

I. General information

NPI: 1457135097
Provider Name (Legal Business Name): JACQUELYN DENISE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-229 WAIPAHU DEPOT ST STE 101
WAIPAHU HI
96797-3032
US

IV. Provider business mailing address

94-229 WAIPAHU DEPOT ST STE 101
WAIPAHU HI
96797-3032
US

V. Phone/Fax

Practice location:
  • Phone: 808-206-9849
  • Fax: 808-206-9850
Mailing address:
  • Phone: 808-206-9849
  • Fax: 808-206-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82922
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82922
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-6050
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: