Healthcare Provider Details

I. General information

NPI: 1548173644
Provider Name (Legal Business Name): JENNA PAWLOSKI, FAMILY HEALTH NURSE PRACTITIONER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 EAST AVE STE 3
CENTRAL SQUARE NY
13036-2677
US

IV. Provider business mailing address

8199 OLD SUNRIDGE DR
MANLIUS NY
13104-2213
US

V. Phone/Fax

Practice location:
  • Phone: 315-507-1062
  • Fax:
Mailing address:
  • Phone: 315-507-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNA PAWLOSKI
Title or Position: OWNER
Credential: NP
Phone: 315-507-1062