Provider Demographics
NPI:1477597557
Name:KARLSEN, JACQUELINE E (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:KARLSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 629
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:315-789-2153
Mailing Address - Fax:315-789-1341
Practice Address - Street 1:64 ELIZABETH BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3403
Practice Address - Country:US
Practice Address - Phone:315-789-2153
Practice Address - Fax:315-789-1341
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333081363L00000X
NYF333081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7080701OtherAETNA
P00194669OtherRAILROAD MEDICARE
NYP019333081OtherBLUE CHOICE OF ROCHESTER
1613866811/001OtherTRICARE
NY000923056002OtherHEALTHNOW,NY
NYNP0757OtherPREFERRED CARE
1613866811/001OtherTRICARE
NYP019333081OtherBLUE CHOICE OF ROCHESTER