Provider Demographics
NPI:1558993386
Name:VINAGRE, JACLYN (APN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:VINAGRE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0524
Mailing Address - Country:US
Mailing Address - Phone:201-359-7557
Mailing Address - Fax:646-376-5140
Practice Address - Street 1:12 E 87TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0524
Practice Address - Country:US
Practice Address - Phone:201-359-7557
Practice Address - Fax:646-376-5140
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01002500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily