Provider Demographics
NPI:1447272992
Name:MAYNARD, JACQUELINE ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANGELA
Last Name:MAYNARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3241 EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3931
Mailing Address - Country:US
Mailing Address - Phone:954-985-6500
Mailing Address - Fax:954-967-8419
Practice Address - Street 1:1430 S POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-718-8700
Practice Address - Fax:954-718-8703
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine