Provider Demographics
NPI:1588469142
Name:HERRERA, JACOLIN (RN)
Entity type:Individual
Prefix:
First Name:JACOLIN
Middle Name:
Last Name:HERRERA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 S CENTENNIAL PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4274
Mailing Address - Country:US
Mailing Address - Phone:801-953-3665
Mailing Address - Fax:
Practice Address - Street 1:5098 W 7870 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-7802
Practice Address - Country:US
Practice Address - Phone:801-953-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8754785-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse