TIMOTHY EDWARD JACKINSKY (NPI# 1528114519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528114519 |
| Entity Type | Individual |
| Full Name | TIMOTHY EDWARD JACKINSKY |
| Credential | NURSE PRACTITIONER |
| Practice Address |
790 S Franklin B Ft Bragg CA 95437 |
| Mailing Address |
13815 Us Highway 101 N Smith River CA 95567-9459 |
| Practice Telephone | 7079644747 |
| Practice Fax Number | 7079622698 |
| Mailing Telephone | 7074875809 |
| Mailing Fax Number | 7079612698 |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2012-06-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | CA452024 | CA | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | CANP16793 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
790 S FRANKLIN B |
| City | FT BRAGG |
| State | CA |
| Zip Code | 95437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902357437 | Mendocino Coast Hospitality Center | Community/Behavioral Health | 137 E. Oak Street, Fort Bragg, CA 95437 | 2016-10-19 |
| 1144604570 | Erin Paul | Community Health Worker | 474 South Franklin Street, Fort Bragg, CA 95437 | 2015-07-15 |
| 1508125790 | Joel Macgregor Green | Marriage & Family Therapist | 331- G Redwood Ave., Fort Bragg, CA 95437 | 2012-05-09 |
| 1013244102 | Jenna Glasscock | Counselor | 331 E Redwood Ave, Ste E, Fort Bragg, CA 95437 | 2009-11-10 |
| 1770819641 | Patrick Lenaghan | Emergency Medicine | 707 River Dr, Fort Bragg, CA 95437 | 2009-10-27 |
| 1043455827 | M. Lee Baker | Dentist | 890 River Dr, Fort Bragg, CA 95437 | 2008-12-09 |
| 1528250495 | Christine Anne Samas | Social Worker | 656a Harrison St., Fort Bragg, CA 95437 | 2007-08-15 |
| 1083822811 | Katharine L. White | Marriage & Family Therapist | 137 E Oak Street, Fort Bragg, CA 95437 | 2007-05-17 |
| 1053525873 | Marty Christine Johnson | Marriage & Family Therapist | 331 E. Redwood Ave, Fort Bragg, CA 95437 | 2007-05-10 |
| 1528114741 | Kate Teresa Donohue | Psychologist | 19201 Noyo Acres Dr, Fort Bragg, CA 95437 | 2007-01-29 |
| Find all providers in zip 95437 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114528817 | Gemekia Latrisha Morales | Nurse Practitioner | 1800 N. California, Stockton, CA 95952 | 2020-11-08 |
| 1447851324 | Anna Patricia Torres | Nurse Practitioner | 1158 Santa Lucia Dr, Pittsburg, CA 94565-7615 | 2020-11-05 |
| 1447851647 | Melanie Ganotisi | Nurse Practitioner | 11541 Blucher Ave Unit 125, Granada Hills, CA 91344-4362 | 2020-11-04 |
| 1659971729 | Raquel Y Mccarthy | Nurse Practitioner | 334 Via Vera Cruz Ste 257, San Marcos, CA 92078-2643 | 2020-10-28 |
| 1689274607 | Aleksandra Zaitseva | Nurse Practitioner | 6850 Sepulveda Blvd Ste 215, Van Nuys, CA 91405-4450 | 2020-10-28 |
| 1215537543 | Gereine Mae Condino Datan | Nurse Practitioner | 500 W 190 St, Gardena, CA 90248 | 2020-10-27 |
| 1861092355 | Vilma Estrada | Nurse Practitioner | 37945 28th St E, Palmdale, CA 93550-5521 | 2020-10-26 |
| 1871192492 | Folashade Jayeoba | Nurse Practitioner | 7453 Tucson Ln, Fontana, CA 92336-0712 | 2020-10-23 |
| 1467051391 | Careforyou LLC | Nurse Practitioner | 806 14th St, Modesto, CA 95354-1023 | 2020-10-21 |
| 1427657550 | Adriana Sarah Pettross | Nurse Practitioner | 35286 Vista De Todo, Capistrano Beach, CA 92624-1847 | 2020-10-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.