Provider Demographics
NPI:1043274392
Name:JAKOVAC, TERRY PAULSEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:PAULSEN
Last Name:JAKOVAC
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HYDE PARK RD
Mailing Address - Street 2:HYDE PARK PLAZA
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-9417
Mailing Address - Country:US
Mailing Address - Phone:724-282-3756
Mailing Address - Fax:724-282-8995
Practice Address - Street 1:451 HYDE PARK RD
Practice Address - Street 2:HYDE PARK PLAZA
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-9417
Practice Address - Country:US
Practice Address - Phone:724-282-3756
Practice Address - Fax:724-282-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN224526L163W00000X
PATP001134G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1991407OtherHIGHMARK
PAJA877419OtherHIGHMARK