Provider Demographics
NPI:1437802113
Name:VELASQUEZ-CASTANEDA, JACQUELINE RUBIDIA (MSN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RUBIDIA
Last Name:VELASQUEZ-CASTANEDA
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GROSS AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3215
Mailing Address - Country:US
Mailing Address - Phone:443-458-3616
Mailing Address - Fax:
Practice Address - Street 1:7615 ORA GLEN DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3642
Practice Address - Country:US
Practice Address - Phone:866-877-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR246402163W00000X, 363LF0000X
DCNP200006078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse