Provider Demographics
NPI:1528767167
Name:MILLARD, JACQUELINE P
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:P
Last Name:MILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAPITAL CARDIOLOGY ASSOCIATES, PC
Mailing Address - Street 2:7 SOUTHWOODS BLVD
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211
Mailing Address - Country:US
Mailing Address - Phone:518-292-6000
Mailing Address - Fax:518-292-6087
Practice Address - Street 1:CAPITAL CARDIOLOGY ASSOCIATES, PC
Practice Address - Street 2:7 SOUTHWOODS BLVD
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211
Practice Address - Country:US
Practice Address - Phone:518-292-6000
Practice Address - Fax:518-292-6087
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily