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General NPI Number Information
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NPI Number | 1871041376
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Entity Type | Individual
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Provider Name | ROSE M JACQUES PMHNP-BC, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 860 GREENBRIER CIR STE 503
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2663
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Country | US
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Telephone | 757-861-9050
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Fax | 757-861-9051
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Provider Business Mailing Address
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Address Line | 860 GREENBRIER CIR STE 503
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2663
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Country | US
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Telephone | 757-861-9050
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Fax | 757-861-9051
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024173718
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024173718
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License Number State | VA
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