MEDICARE: MS. JACQUELYNN VICTORIA TITUS FNP

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	363LP0200X	Pediatric Nurse Practitioner	2020039600	MO
2	363LF0000X	Family Nurse Practitioner	2020039600	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710431432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELYNN VICTORIA TITUS FNP

Provider Business Mailing Address
First Line	:	PO BOX 772866
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0166
Country	:	US
Telephone Number	:	314-364-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PL
Second Line	:	DIV PED EMERGENCY MED
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-6000
Fax Number	:	314-747-3338

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

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	03/02/2026

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