Provider Demographics
NPI:1932931532
Name:DUFFY, JACQUELINE ANTOINETTE (AGAC-NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ANTOINETTE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:628 BLACKWATER RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-1349
Mailing Address - Country:US
Mailing Address - Phone:951-514-6114
Mailing Address - Fax:
Practice Address - Street 1:2025 GLENN MITCHELL DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0178
Practice Address - Country:US
Practice Address - Phone:757-507-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001250790163W00000X
VA0024190128363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse