Provider Demographics
NPI:1982895611
Name:JACQUES, DAWN APRYL (PA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:APRYL
Last Name:JACQUES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:APRYL
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:17506 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2949
Mailing Address - Country:US
Mailing Address - Phone:917-892-3022
Mailing Address - Fax:
Practice Address - Street 1:17506 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2949
Practice Address - Country:US
Practice Address - Phone:917-892-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009849363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical