Provider Demographics
NPI:1669809828
Name:ISAAC, JAISY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JAISY
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 STEELE WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3115
Mailing Address - Country:US
Mailing Address - Phone:267-226-3332
Mailing Address - Fax:
Practice Address - Street 1:7924 BUSTLETON AVE
Practice Address - Street 2:PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3321
Practice Address - Country:US
Practice Address - Phone:267-226-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012064363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health