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General NPI Number Information
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NPI Number | 1609326776
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Entity Type | Individual
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Provider Name | JACQUELINE ANDERSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 5100 N 12TH AVE STE 101
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City | PENSACOLA
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State | FL
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Zip | 32504-8919
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Country | US
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Telephone | 850-208-6130
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Fax | 850-208-6136
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Provider Business Mailing Address
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Address Line | PO BOX 95590
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0590
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Country | US
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Telephone | 801-352-9500
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Fax | 801-352-7976
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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 | SP016493
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License Number State | PA
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