Healthcare Provider Details

I. General information

NPI: 1881244473
Provider Name (Legal Business Name): JACQUELINE FLORES APRN- CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE STE 1304
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3333
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-3200
  • Fax: 918-502-3205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number89100
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number89100
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number89100
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: