Provider Demographics
NPI:1912761438
Name:O'CONNOR, JACLYN T (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:T
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 MISTY SAGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6848
Mailing Address - Country:US
Mailing Address - Phone:702-461-4129
Mailing Address - Fax:
Practice Address - Street 1:6380 S VALLEY VIEW BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3910
Practice Address - Country:US
Practice Address - Phone:702-558-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily