Provider Demographics
NPI:1720748825
Name:SPRINGER, JACLYN N (CRNP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:N
Last Name:SPRINGER
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 1:221 E HORNER ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1422
Mailing Address - Country:US
Mailing Address - Phone:814-421-3562
Mailing Address - Fax:
Practice Address - Street 1:1511 SCALP AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3348
Practice Address - Country:US
Practice Address - Phone:814-254-4207
Practice Address - Fax:814-254-4733
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily