Individual
JACQUELINE LYNETTE DE LA GARZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
67-1123 MAMALAHOA HWY STE 120124, KAMUELA, HI 96743-8451
(808) 881-4710
Mailing address
GENERAL DELIVERY, VOLCANO, HI 96785-9999
(808) 430-0654
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-106817
HI
363LF0000X
Family Nurse Practitioner
Primary
APRN-3777
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN-3777
APRN LICENSURE
HI
01
—
RN-106817
HI RN LICENSURE
HI
Enumeration date
02/27/2023
Last updated
07/02/2024
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