Provider Demographics
NPI:1861044588
Name:ARACKAL, JOCELYN (FNP,)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:ARACKAL
Suffix:
Gender:F
Credentials:FNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1992
Mailing Address - Country:US
Mailing Address - Phone:847-303-2451
Mailing Address - Fax:
Practice Address - Street 1:2045 PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1992
Practice Address - Country:US
Practice Address - Phone:847-303-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.390946163W00000X
IL209019502363LA2200X
IL209.019502363LF0000X
IL277.001769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209019502Medicaid
IL209019502Medicaid