MEDICARE: JACQUELINE MARIE FROCKT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	881286	NV

General Provider Information

NPI Number	:	1447058763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MARIE FROCKT APRN

Provider Business Mailing Address
First Line	:	4327 SPOONER LAKE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0403
Country	:	US
Telephone Number	:	702-335-8243
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S RANCHO DR STE I67
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4862
Country	:	US
Telephone Number	:	702-243-4700
Fax Number	:	702-243-7074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	02/04/2026

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