Healthcare Provider Details

I. General information

NPI: 1609965631
Provider Name (Legal Business Name): JOYCE GARCIA JACQUET CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 NAPA BLVD
AVON OH
44011-4507
US

IV. Provider business mailing address

3435 NAPA BLVD
AVON OH
44011-4507
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-0346
  • Fax: 440-937-0373
Mailing address:
  • Phone: 440-937-0346
  • Fax: 440-937-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number49333
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: