Provider Demographics
NPI:1942683248
Name:NUNEZ, JACQUELYN ELIZABETH (MMSC, PA-C, ATC)
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:ELIZABETH
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MMSC, PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 JESSE HILL JR DR SE FL 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3049
Mailing Address - Country:US
Mailing Address - Phone:404-778-1550
Mailing Address - Fax:404-778-1552
Practice Address - Street 1:80 GILMER STREET SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AS0400X
GA11465363AS0400X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer