Provider Demographics
NPI:1215256516
Name:HEUER, JACLYN M (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:M
Last Name:HEUER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DEFOREST CT
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1327
Mailing Address - Country:US
Mailing Address - Phone:845-558-4574
Mailing Address - Fax:
Practice Address - Street 1:156 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5005
Practice Address - Country:US
Practice Address - Phone:845-357-8660
Practice Address - Fax:845-357-9170
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00712900363LA2200X
NY306237363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health