Provider Demographics
NPI:1386752228
Name:SEBASTIAN, JACQUELINE SUZANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:SUZANNE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:SUZANNE
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 BARRETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7213
Mailing Address - Country:US
Mailing Address - Phone:919-231-3966
Mailing Address - Fax:919-231-3912
Practice Address - Street 1:790 SE CARY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5678
Practice Address - Country:US
Practice Address - Phone:919-231-3966
Practice Address - Fax:919-231-3912
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5002018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3278OtherSC APRN LISCENSE