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General NPI Number Information
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NPI Number | 1730095068
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Entity Type | Individual
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Provider Name | JACKIE JULISSA FLORES
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Gender | Female
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 11151 DIAMOND STREAM DR
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City | SPARKS
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State | NV
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Zip | 89441-5239
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Country | US
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Telephone | 775-348-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 10345 PROFESSIONAL CIR STE 125
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City | RENO
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State | NV
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Zip | 89521-3100
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Country | US
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Telephone | 775-348-7300
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 892879
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License Number State | NV
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