Provider Demographics
NPI:1750153631
Name:ROSARIO, JACLYN (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 TORRINGTON RDG
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-7991
Mailing Address - Country:US
Mailing Address - Phone:330-205-4714
Mailing Address - Fax:
Practice Address - Street 1:84 TORRINGTON RDG
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-7991
Practice Address - Country:US
Practice Address - Phone:330-205-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023128263363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner