Healthcare Provider Details

I. General information

NPI: 1730525056
Provider Name (Legal Business Name): JACQUELINE ESPINAL R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10719 87TH ST
OZONE PARK NY
11417-1406
US

IV. Provider business mailing address

10719 87TH ST
OZONE PARK NY
11417-1406
US

V. Phone/Fax

Practice location:
  • Phone: 917-912-2149
  • Fax:
Mailing address:
  • Phone: 917-912-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number662715-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: