Healthcare Provider Details

I. General information

NPI: 1659181568
Provider Name (Legal Business Name): BEVERLY A JAKIC APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 W MEDICAL CENTER DR STE 1
MCHENRY IL
60050-8425
US

IV. Provider business mailing address

4305 W MEDICAL CENTER DR STE 1
MCHENRY IL
60050-8425
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-8100
  • Fax: 815-759-8106
Mailing address:
  • Phone: 815-759-8100
  • Fax: 815-759-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031210
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.031210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: