Individual
JACQUELYN PATRICE SQUARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 CIVIC CENTER BLVD, PCAM 3 RD FLOOR, PHILADELPHIA, PA 19104-5158
(215) 662-6397
Mailing address
312 FOREST HILLS AVE, PHILADELPHIA, PA 19116-1010
(215) 917-9496
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP026487
PA
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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