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General NPI Number Information
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NPI Number | 1326660978
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Entity Type | Individual
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Provider Name | JACQUELINE FRAZER ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 3040 E COLLEGE AVE
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City | RUSKIN
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State | FL
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Zip | 33570-5220
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Country | US
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Telephone | 813-331-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 SONG SPARROW CT
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City | RUSKIN
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State | FL
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Zip | 33570-8007
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11010652
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 646848
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | RN9304259
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License Number State | FL
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