Provider Demographics
NPI:1215488697
Name:TOAL, JACQUELINE JONES
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JONES
Last Name:TOAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:228 NE JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3802
Mailing Address - Country:US
Mailing Address - Phone:309-671-8000
Mailing Address - Fax:
Practice Address - Street 1:228 NE JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3802
Practice Address - Country:US
Practice Address - Phone:309-671-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014994363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health