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General NPI Number Information
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NPI Number | 1356403778
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Entity Type | Individual
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Provider Name | JESSICA L HALOSKIE MD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 3870 W RIVER RD STE 126
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City | TUCSON
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State | AZ
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Zip | 85741-3080
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Country | US
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Telephone | 520-219-6616
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Fax | 520-742-6187
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 520-219-6616
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Fax | 520-742-6187
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.119948
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0170108A
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License Number State | IN
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