Provider Demographics
NPI:1912490624
Name:JACQUES, ARIELLA CANDACE MARIE (MD)
Entity type:Individual
Prefix:
First Name:ARIELLA
Middle Name:CANDACE MARIE
Last Name:JACQUES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARIELLA
Other - Middle Name:
Other - Last Name:DERENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2612
Mailing Address - Country:US
Mailing Address - Phone:602-839-2000
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:SUITE 5A43
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-623-0188
Practice Address - Fax:302-733-5640
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0027096207R00000X
AZMT215080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine