Provider Demographics
NPI:1750897179
Name:ATKIN, JACQUELINE ISABEL (ARNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ISABEL
Last Name:ATKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3430
Mailing Address - Country:US
Mailing Address - Phone:954-653-2196
Mailing Address - Fax:954-653-2499
Practice Address - Street 1:2000 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3430
Practice Address - Country:US
Practice Address - Phone:954-653-2196
Practice Address - Fax:954-653-2499
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9326640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily