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General NPI Number Information
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NPI Number | 1235790577
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Entity Type | Individual
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Provider Name | JACLYN LASITA RN, PNP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 263 BLUE POINT AVE
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City | BLUE POINT
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State | NY
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Zip | 11715-1224
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Country | US
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Telephone | 631-419-6737
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Fax |
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Provider Business Mailing Address
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Address Line | 63 TARPON RD
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City | ROCKY POINT
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State | NY
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Zip | 11778-9579
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Country | US
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Telephone | 631-740-0769
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F383584
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 745257
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 745257
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License Number State | NY
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