Provider Demographics
NPI:1477005353
Name:ZUBIATE, JACLYN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ZUBIATE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GOODALL DR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-5214
Mailing Address - Country:US
Mailing Address - Phone:207-490-7760
Mailing Address - Fax:
Practice Address - Street 1:10 GOODALL DR
Practice Address - Street 2:SUITE 900
Practice Address - City:EAST WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030-5214
Practice Address - Country:US
Practice Address - Phone:207-490-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP161160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily