Healthcare Provider Details

I. General information

NPI: 1841549102
Provider Name (Legal Business Name): JILL JACOSKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BINGHAM AVE
OCEAN NJ
07712-4762
US

IV. Provider business mailing address

11 MERIDIAN RD
EATONTOWN NJ
07724-2242
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-3916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number26NR13921600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00393100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: