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General NPI Number Information
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NPI Number | 1073274171
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Entity Type | Organization
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Legal Business Name | JACQUE' INC
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Dates
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Enumeration Date | 01/01/2022
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Last Update Date | 01/01/2022
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Provider Practice Location Address
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Address Line | 3291 NE 2ND AVE STE 10
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City | OAKLAND PARK
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State | FL
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Zip | 33334-1101
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Country | US
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Telephone | 786-496-4091
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Fax |
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Provider Business Mailing Address
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Address Line | 166 NW 103RD ST
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City | MIAMI SHORES
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State | FL
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Zip | 33150-1236
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Country | US
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Telephone | 786-266-7591
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE M SMALL
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Credential | DMSC, PA-C
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Telephone | 786-266-7591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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