Individual
DR. NICOLE BEALL JAQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
105 REDBUD DR, EMERGENCY DEPARTMENT, PORTLAND, TN 37148-1673
(615) 745-8150
Mailing address
105 REDBUD DR, EMERGENCY DEPARTMENT, PORTLAND, TN 37148-1673
(615) 745-8150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
45895
TN
207Q00000X
Family Medicine Physician
Primary
45895
TN
Other
Enumeration date
03/27/2008
Last updated
01/13/2015
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