Provider Demographics
NPI:1972036333
Name:ABRAHALL, JACLYN C (FNP-C, CDCES)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:C
Last Name:ABRAHALL
Suffix:
Gender:F
Credentials:FNP-C, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MOTOR PKWY STE C-16
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5114
Mailing Address - Country:US
Mailing Address - Phone:631-638-4933
Mailing Address - Fax:
Practice Address - Street 1:200 MOTOR PKWY STE C-16
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5114
Practice Address - Country:US
Practice Address - Phone:631-638-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695786163WD0400X
NY343035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator