Provider Demographics
NPI:1073794574
Name:STAAL, JACQUELINE B (ARNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:B
Last Name:STAAL
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 1:8595 COLLEGE PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5191
Mailing Address - Country:US
Mailing Address - Phone:239-481-9999
Mailing Address - Fax:
Practice Address - Street 1:8595 COLLEGE PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5191
Practice Address - Country:US
Practice Address - Phone:239-481-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9204631163W00000X
FLARNP 9204631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse