Provider Demographics
NPI:1982709242
Name:JOHNSTON, JACQUELINE P (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:P
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:PATRICIA
Other - Last Name:CARTABUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:11 TOPLAND PL
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1938
Mailing Address - Country:US
Mailing Address - Phone:516-877-6004
Mailing Address - Fax:516-877-6008
Practice Address - Street 1:ADELPHI UNIVERSITY, ONE SOUTH AVE
Practice Address - Street 2:WALDO HALL, HEALTH SERVICES
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-877-6004
Practice Address - Fax:516-877-6008
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303629363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ08343Medicare UPIN
NY0370G1Medicare ID - Type Unspecified