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General NPI Number Information
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NPI Number | 1184166753
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Entity Type | Individual
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Provider Name | JACINDA HANTAK APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2016
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 4400 GRANT BLVD
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City | YUKON
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State | OK
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Zip | 73099-0037
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Country | US
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Telephone | 405-603-4660
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Fax | 405-470-3377
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Provider Business Mailing Address
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Address Line | 4400 GRANT BLVD
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City | YUKON
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State | OK
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Zip | 73099-0037
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Country | US
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Telephone | 405-603-4660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 96351
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License Number State | OK
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