Provider Demographics
NPI:1003475864
Name:COMINOTTO, JACLYN R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:R
Last Name:COMINOTTO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 THALIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1147
Mailing Address - Country:US
Mailing Address - Phone:586-453-4907
Mailing Address - Fax:
Practice Address - Street 1:1642 WESTGATE CIR STE 202
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8195
Practice Address - Country:US
Practice Address - Phone:615-941-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000025683363LF0000X
MI4704302387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily