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General NPI Number Information
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NPI Number | 1770839151
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Entity Type | Individual
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Provider Name | MARIE JACQUES NP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 20003 LINDEN BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3223
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Country | US
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Telephone | 718-525-5505
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD DR S
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3717
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 337440
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License Number State | NY
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