Healthcare Provider Details

I. General information

NPI: 1689286502
Provider Name (Legal Business Name): JACQUELINE S HOJATI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 86TH ST
URBANDALE IA
50322-4309
US

IV. Provider business mailing address

2633 86TH ST
URBANDALE IA
50322-4309
US

V. Phone/Fax

Practice location:
  • Phone: 515-252-2552
  • Fax: 515-598-7697
Mailing address:
  • Phone: 515-252-2552
  • Fax: 515-598-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA160441
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: