Provider Demographics
NPI:1568235414
Name:POLLOCK, JACQUELINE ELYSE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ELYSE
Last Name:POLLOCK
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 1:1002 N 2ND ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1684
Mailing Address - Country:US
Mailing Address - Phone:215-595-7789
Mailing Address - Fax:
Practice Address - Street 1:111 SOUTH 11TH ST
Practice Address - Street 2:GIBBON BUILDING, SUITE G6210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily