Provider Demographics
NPI:1366702862
Name:PATEL, JACQUELINE LAVELLE (DNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LAVELLE
Last Name:PATEL
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 ADCOCK LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1061
Mailing Address - Country:US
Mailing Address - Phone:443-743-0497
Mailing Address - Fax:
Practice Address - Street 1:1015 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3918
Practice Address - Country:US
Practice Address - Phone:443-743-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118542363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health