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General NPI Number Information
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NPI Number | 1568138501
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Entity Type | Individual
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Provider Name | JACLYN MARIE TALASKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 1100 PIKE ST
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City | HUNTINGDON
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State | PA
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Zip | 16654-0002
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Country | US
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Telephone | 814-643-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 VAN BUREN AVE
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City | ALTOONA
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State | PA
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Zip | 16602-6107
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Country | US
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Telephone | 814-730-7838
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA062754
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License Number State | PA
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