Provider Demographics
NPI:1346517851
Name:JACARUSO-MRKULIC, DANIELLE JEANNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:JEANNE
Last Name:JACARUSO-MRKULIC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:JEANNE
Other - Last Name:JACARUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3938
Mailing Address - Country:US
Mailing Address - Phone:516-574-1107
Mailing Address - Fax:
Practice Address - Street 1:1 PENN PLZ FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0899
Practice Address - Country:US
Practice Address - Phone:516-574-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336923-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily