Provider Demographics
NPI:1679560718
Name:ARIETA, JACQUELYN M (FNP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:M
Last Name:ARIETA
Suffix:
Gender:F
Credentials:FNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 COMMERCE ST
Mailing Address - Street 2:ANCHOR MEDICAL ASSOCIATES PEDIATRIC DEPARTMENT
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1168
Mailing Address - Country:US
Mailing Address - Phone:401-793-8484
Mailing Address - Fax:401-793-8481
Practice Address - Street 1:1 COMMERCE ST
Practice Address - Street 2:ANCHOR MEDICAL ASSOCIATES PEDIATRIC DEPARTMENT
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1168
Practice Address - Country:US
Practice Address - Phone:401-793-8484
Practice Address - Fax:401-793-8481
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA152166363L00000X
RIRN25654363LF0000X
RICAPRN00817363LF0000X
RIAPRN00817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0799785Medicaid
RI31351-3OtherBCBSRI
MA78089OtherCHILDRENS MEDICAL SECURIT
MA0037810OtherNEIGHBORHOOD HEALTH PLAN
RI413415OtherBCBSRIBLUCHIP
MANP2548OtherBCBSMA
P10856Medicare UPIN
RI31351-3OtherBCBSRI