Individual
JACQUELINE ANNE ROONEY-UDICIOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
729 GROVE AVE, SOUTHAMPTON, PA 18966-6008
(215) 322-0800
(215) 322-2073
Mailing address
729 GROVE AVE, SOUTHAMPTON, PA 18966-6008
(215) 322-0800
(215) 322-2073
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP009936
PA
363LP0200X
Pediatric Nurse Practitioner
SP009936
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10225936440001
—
PA
01
—
RN565963
PA. RN LICENSE
PA
01
—
SP009936
PA CERTIFIED NURSE PRACTITIONER LICENSE
PA
Enumeration date
06/18/2009
Last updated
02/19/2026
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