MEDICARE: JACQUELINE COOKE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71005252A	IN

General Provider Information

NPI Number	:	1508261728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE COOKE NP

Provider Business Mailing Address
First Line	:	8732 S 800 W
Second Line	:
City	:	WANATAH
State	:	IN
Zip	:	46390-9532
Country	:	US
Telephone Number	:	219-309-5780
Fax Number	:	219-209-5774

Provider Business Practice Location Address
First Line	:	521 E 86TH AVE STE Z
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6236
Country	:	US
Telephone Number	:	847-920-0902
Fax Number	:	219-209-5774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	01/10/2026

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