Provider Demographics
NPI:1780935684
Name:TRCKA, JACQUELINE E (APN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:TRCKA
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 S MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2727
Mailing Address - Country:US
Mailing Address - Phone:312-208-2860
Mailing Address - Fax:
Practice Address - Street 1:527 S MARTHA ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2727
Practice Address - Country:US
Practice Address - Phone:331-551-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily