Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacqueline Otake

Individual provider Certified Registered Nurse Anesthetist · NPI 1720769763

Jacqueline Otake is a Certified Registered Nurse Anesthetist (CRNA) in Albuquerque, New Mexico. Qualified in 2024, 2 years ago. Practices with St Alphonsus Professional Medical Services LLC, a 123-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in New Hampshire, New Mexico and Texas.

Years since qualifying
2
Licensed in
NH, NM, TX
In the registry since
2023
Specialties on file
3
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Practice location Address checks out

1100 Central Ave SE
Albuquerque, NM 87106-4930
Phone: (505) 841-1234
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 5 Alumni Dr, Exeter, NH 03833-2160 — (603) 778-7311
  • 12222 Merit Dr Ste 600, Dallas, TX 75251-3294 — (972) 715-5000

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 1229584 (TX)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 80042 (NM)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 114672-23 (NH)

Record details

NPI number1720769763
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 31, 2023
Last updated in NPPESJuly 16, 2026
Certification dateJuly 16, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice St Alphonsus Professional Medical Services Llc — 123 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Albuquerque