Individual
JACQUELINE ANGELA DACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4133 CHAPEL LAKE DR, DECATUR, GA 30034-3568
(404) 549-8086
(404) 549-8086
Mailing address
4133 CHAPEL LAKE DR, DECATUR, GA 30034-3568
(404) 549-8086
(404) 549-8086
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN079303
GA
Other
Enumeration date
07/07/2015
Last updated
07/07/2015
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