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NPI Code Detail

MEDICARE: MRS. KELLIE LINNE JARZEMBAK APRN,ACNP-BC

MEDICARE:  MRS. KELLIE LINNE JARZEMBAK  APRN,ACNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerC-APN.0104342-C-NPCO
2363L00000XNurse Practitioner322153AZ
3363L00000XNurse PractitionerAPRN11020801FL
4363L00000XNurse Practitioner15289OH
5363L00000XNurse Practitioner209027334IL
6363L00000XNurse Practitioner3-002715AL
7363L00000XNurse Practitioner2026005115MO

General Provider Information

NPI Number : 1538597000
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLIE LINNE JARZEMBAK APRN,ACNP-BC
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Provider Business Practice Location Address
First Line : 3700 PARK EAST DR STE 450
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-4318
Country : US
Telephone Number : 668-490-6928
Fax Number : 888-973-8821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2013
Last Update Date : 02/05/2026

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