Healthcare Provider Details

I. General information

NPI: 1013376474
Provider Name (Legal Business Name): JACQUELYN M FLOWERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 RIVERS EDGE DR
COLUMBUS OH
43235-1329
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-533-4000
  • Fax: 614-540-3979
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18783-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: