Provider Demographics
NPI:1154574879
Name:JOFFRAY, JACQUELIN ANNETTE (APRN)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:ANNETTE
Last Name:JOFFRAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WILCREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2754
Mailing Address - Country:US
Mailing Address - Phone:888-909-6409
Mailing Address - Fax:364-888-5268
Practice Address - Street 1:2500 WILCREST DR, SUITE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2754
Practice Address - Country:US
Practice Address - Phone:888-909-6409
Practice Address - Fax:364-888-5268
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV820387363LP0808X, 363LP0808X, 363LP0808X
TXAP118263363LP0808X, 363LP0808X
OR201904224NP-PP363LP0808X
DCRN1028783363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty