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General NPI Number Information
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NPI Number | 1164922811
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Entity Type | Individual
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Provider Name | JACQUELINE OOTEN
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Gender | Female
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 601 7TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4708
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Country | US
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Telephone | 727-893-6234
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Fax | 727-553-7422
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Provider Business Mailing Address
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Address Line | 601 7TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4708
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Country | US
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Telephone | 727-893-6234
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Fax | 727-553-7422
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 9319063
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11002579
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11002579
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License Number State | FL
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