Healthcare Provider Details

I. General information

NPI: 1376398107
Provider Name (Legal Business Name): JACQUELYN T. MARSHALL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN T MARCHAND NP

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WATER ST
MILFORD MA
01757-3015
US

IV. Provider business mailing address

115 WATER ST STE 104
MILFORD MA
01757-3015
US

V. Phone/Fax

Practice location:
  • Phone: 774-462-3380
  • Fax:
Mailing address:
  • Phone: 774-462-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2339787
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2339787
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: