Provider Demographics
NPI:1922437805
Name:JASKOLKA, STACEY (MSN, RN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:JASKOLKA
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 NEWELL ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5313
Mailing Address - Country:US
Mailing Address - Phone:315-798-9300
Mailing Address - Fax:315-793-8320
Practice Address - Street 1:807 NEWELL ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5313
Practice Address - Country:US
Practice Address - Phone:315-798-9300
Practice Address - Fax:315-793-8320
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306718363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health