Healthcare Provider Details

I. General information

NPI: 1497601017
Provider Name (Legal Business Name): JACOB IAN POLLINA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3204
US

IV. Provider business mailing address

1607 VINE AVE
ROUND LAKE BEACH IL
60073-2231
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-2900
  • Fax:
Mailing address:
  • Phone: 224-814-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02260882
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: