Healthcare Provider Details

I. General information

NPI: 1194967372
Provider Name (Legal Business Name): JACQUELINE AUGSBURGER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WESTERN BLVD
JACKSONVILLE NC
28546-6379
US

IV. Provider business mailing address

113 QUAILWOOD CIR
CAPE CARTERET NC
28584-9749
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-2240
  • Fax: 910-577-2439
Mailing address:
  • Phone: 252-393-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: