Individual
GLORIA SIMO JAQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF MEDICINE/WOUND CARE GMED, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, UNIVERSITY PHYSICIANS, JACKSON, MS 39216-4500
(601) 984-1000
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R850494
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06432790
—
MS
01
—
P01454792
RAILROAD MEDICARE PTAN
MS
Enumeration date
10/09/2012
Last updated
06/18/2015
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