Healthcare Provider Details

I. General information

NPI: 1760307961
Provider Name (Legal Business Name): JAQUELINE MARTINEZ OCAMPO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 HYLAND GREENS DR APT 727
BLOOMINGTON MN
55437-3914
US

IV. Provider business mailing address

5301 HYLAND GREENS DR APT 727
BLOOMINGTON MN
55437-3914
US

V. Phone/Fax

Practice location:
  • Phone: 405-473-2392
  • Fax:
Mailing address:
  • Phone: 405-473-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2516371
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: