Provider Demographics
NPI:1336180470
Name:SARKEY, JENNIFER C (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:SARKEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:708-862-1781
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 3300
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-915-8660
Practice Address - Fax:708-957-5919
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001933A363L00000X
IL209005464363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40922Medicare UPIN
IL437901Medicare ID - Type UnspecifiedMCARE GROUP PROV #
ILK20139Medicare ID - Type UnspecifiedMCARE INDIV PROV #
Q40922Medicare UPIN
IL437901Medicare ID - Type UnspecifiedMCARE GROUP PROV #