Provider Demographics
NPI:1386422533
Name:BORDEN, JACQUELINE ANN (CRNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:BORDEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3135 APPLE BUTTER RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18038-9406
Mailing Address - Country:US
Mailing Address - Phone:912-713-6365
Mailing Address - Fax:
Practice Address - Street 1:1250 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027888363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health