Basic Information
| Provider Information | |||||||||
| NPI: | 1508001868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIRADO | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2434 | ||||||||
| Address2: | |||||||||
| City: | ISABELA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00662 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | HOSPITAL CIMA CARRETERA 112 INTERIOR | ||||||||
| Address2: | |||||||||
| City: | ISABELA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878302747 | ||||||||
| FaxNumber: | 7878300465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2008 | ||||||||
| LastUpdateDate: | 12/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 31683 | PR | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.