Provider Demographics
NPI:1790098671
Name:HOSTETTER, JACQUELINE M (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:HOSTETTER
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 1:1100 S CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-2547
Mailing Address - Country:US
Mailing Address - Phone:717-238-7662
Mailing Address - Fax:717-238-7894
Practice Address - Street 1:100 SOUTH CAMERON ST.
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:10104-2547
Practice Address - Country:US
Practice Address - Phone:717-238-7662
Practice Address - Fax:717-238-7894
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005043363LP0808X
PASP010838363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health