Individual
MRS. JACQUELINE COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7952 N 43RD AVE, GLENDALE, AZ 85301-1662
(623) 628-6893
Mailing address
9803 W ECHO LN, PEORIA, AZ 85345-3723
(623) 628-6893
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
239048
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
239048
CERTIFIED NURSE PRACTITIONER
AZ
Enumeration date
03/05/2020
Last updated
03/05/2020
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