Provider Demographics
NPI:1528445723
Name:HOLMBERG, JACQUELYN (MS, RN, ACNS-BC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:MS, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2000
Mailing Address - Country:US
Mailing Address - Phone:617-791-5501
Mailing Address - Fax:
Practice Address - Street 1:16 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2000
Practice Address - Country:US
Practice Address - Phone:617-791-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN251347364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care