Provider Demographics
NPI:1992916696
Name:BAILEY, JACQUELINE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:CODERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2823 S ABINGDON ST # A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1311
Mailing Address - Country:US
Mailing Address - Phone:860-930-8193
Mailing Address - Fax:
Practice Address - Street 1:920 2ND AVENUE S,
Practice Address - Street 2:SUITE 400 MINUTE CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-3318
Practice Address - Country:US
Practice Address - Phone:612-659-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1005023363LF0000X
VA0024167578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA017384M58Medicare UPIN
VA143394ZCCUMedicare PIN