MEDICARE: BRITTANY LYNN JACK

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	364SR0400X	Rehabilitation Clinical Nurse Specialist	RN73527	ME
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	RN73527	ME

General Provider Information

NPI Number	:	1699634659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY LYNN JACK

Provider Business Mailing Address
First Line	:	276 RAZORVILLE RD
Second Line	:
City	:	WASHINGTON
State	:	ME
Zip	:	04574-3817
Country	:	US
Telephone Number	:	207-845-2232
Fax Number	:

Provider Business Practice Location Address
First Line	:	276 RAZORVILLE RD
Second Line	:
City	:	WASHINGTON
State	:	ME
Zip	:	04574-3817
Country	:	US
Telephone Number	:	207-845-2232
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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