Individual
JACQUELIN L. CORP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
315 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4234
(253) 403-1000
(534) 031-2232
Mailing address
PO BOX 5299, MS: 820-5-PCO, TACOMA, WA 98415-0299
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60834534
WA
363LF0000X
Family Nurse Practitioner
78342
WV
Other
Enumeration date
09/28/2012
Last updated
07/28/2023
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