Healthcare Provider Details

I. General information

NPI: 1265257927
Provider Name (Legal Business Name): JACLYN DANIELLE ZASAITIS DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 2140
CHICAGO IL
60611-3143
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 2140
CHICAGO IL
60611-3143
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-1800
  • Fax: 312-695-3644
Mailing address:
  • Phone: 312-695-1800
  • Fax: 312-695-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209029980
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.029980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: