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General NPI Number Information
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NPI Number | 1134604598
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Entity Type | Individual
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Provider Name | JAQUELINE FERNANDEZ-QUEZADA CNP
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Gender | Female
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 3450 ZAFARANO DR UNIT C
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City | SANTA FE
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State | NM
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Zip | 87507-2669
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Country | US
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Telephone | 505-466-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 4408 SANTA LUCIA
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City | SANTA FE
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State | NM
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Zip | 87507-7401
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Country | US
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Telephone | 505-231-4105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-53942
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License Number State | NM
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