Healthcare Provider Details

I. General information

NPI: 1659637130
Provider Name (Legal Business Name): JACLYN GUARINO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GALLERY DR STE 300
MC MURRAY PA
15317-2690
US

IV. Provider business mailing address

160 GALLERY DR STE 300
MC MURRAY PA
15317-2690
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-7144
  • Fax: 724-941-7625
Mailing address:
  • Phone: 724-941-7144
  • Fax: 724-941-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011756
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102753640
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: