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General NPI Number Information
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NPI Number | 1568235414
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Entity Type | Individual
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Provider Name | JACQUELINE ELYSE POLLOCK CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 111 SOUTH 11TH ST GIBBON BUILDING, SUITE G6210
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 215-955-8304
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 N 2ND ST UNIT 411
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1684
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Country | US
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Telephone | 215-595-7789
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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 | SP028556
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License Number State | PA
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