Individual
MR. JACK A KOOIENGA
Active
Individual
MR. JACK A KOOIENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN11012762
FL
363LC0200X
Critical Care Medicine Nurse Practitioner
4704218318
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110773300
—
FL
Enumeration date
09/07/2012
Last updated
08/09/2021
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